. U3RARY
. . MARYLAND,/
BALTIMORE
MISSISSIPPI DOCTOP
Volume 23 - 24
1943 - 1947
VOL. 23
Mississippi Doctor
BOONEVILLE, MISSISSIPPI,. JI>NE,'. 1945 NO. 1
Tolerance
The most lovable and livable quality that
any human being can possess is tolerance.
Tolerance is the vision that enables us to see
things from another’s point of view. It is
the generosity of spirit that concedes to others
the right to their own opinion and individual-
ity. It is the breadth of mind that enables us
to want those whom we love and respect to
be happy in their own way and not in our way.
AO TILLYER
WITH “THE FRINGE ON TOP
Vue BIFOCALS
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fringes. This color reduction feature is accomplished in most Ful-Vue Bifocal seg-
c c r c C c t c
ments through the Use of Barium glass— in nigh minus corrections through the use of
dense flint glass in the segments;
To give your patients full satisfaction, prescribe Tilly er Ful-Vue Bifocals for
maximum comfort. Ask your American Optical representative for demonstration.
American Optical
COMPANY
S. N. Brinson, M.D.
Medical Director
Walter R. Wallace
Business Manager
THE WALLACE SANITARIUM
MEMPHIS y* TENNESSEE
For over thirty years in successful operation, just eight miles from the heart of the city, in
a quiet suburb, occupying sixteen acres of beautiful grounds, this Sanitarium is especially
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the care of patients requiring metrazol and insulin therapy and is ideal for convalescents.
Fulminating Abdominal Catastrophes*
GEORGE H. MARTIN, M.D. and AUGUSTUS STREET, M.D., F.A.C.S.
Vicksburg, Miss.
The title of this paper was selected in
hopes of conveying to the mind of the
reader a picture of the sudden, severe, and
often overwhelming conditions that may oc-
cur in the abdomen.
In no other field of surgery is there such
a demand for quick thinking and sound judg-
ment as is encountered in the so-called acute
abdomen. Here is truly a surgical emergency
requiring that we strive for the utmost in
diagnostic acumen and the ultra in surgical
judgment. Although a final diagnosis cannot
be made until the abdomen is opened one must
always attempt to obtain an accurate pre-
operative impression for upon such is based
the rational approach to the surgical prob-
lem.9 Once a correct diagnosis is made the
well trained surgeon has little difficulty in
adequately treating a patient with acute ab-
dominal manifestations.
Conditions which may produce a fulminating
acute abdomen may be classified as follows:7
1) inflammation; 2) obstruction; 3) perfora-
tion; 4) hemorrhage; and 5) trauma.
INFLAMMATION
Appendicitis — The most frequent cause for
an acute abdomen is of course appendicitis. The
usual syndrome of pain beginning around the
umbilicus, radiating to the right lower quad-
ran'; to become localized beneath McBurney’s
point, together with nausea, vomiting, rigidity
in the right side, moderate leukocytosis, and
low grade fever is familiar to us all and needs
no further discussion at this time. 2
We are interested however in the ruptured
appendix and the ruptured appendiceal ab-
scess, for here a relatively simple surgical
problem of the acute appendix has been con-
verted into a serious surgical emergency with
a high mortality rate. The usual picture of
a ruptured appendix following an acute in-
f’ammatory appendicitis which has been neg-
lected or abused by the giving of cathartics
need give no great concern in the differential
diagnosis, but there is one type of appendicitis
which is especially treacherous. This is ob-
*From the Surgical Section of The Street Clinic,
Vicksburg-, Mississippi. Read before Central Medical
Society Annual Meeting-, Jackson, Mississippi De-
cember, 1944.
structive appendicitis. In this condition the
typical syndrome is not present. The patient
may complain only of colicky pain which may
not be severe. There may or may not be nau-
sea or vomiting. The leukocyte count may be
perfectly normal. There is little or no peri-
toneal irritation and usually no rigidity. In
spite of a lack of warning signs perforation
usually occurs early due to the obstructive
nature of the condition and rupture occurs
into a virgin peritoneal cavity which has not
become walled off by inflammatory exudate
about the appendix. The picture is one of a
sudden spreading peritonitis with few local-
izing signs. One is then faced with the prob-
lem of dealing with a generalized peritonitis
rather than a local disease of the appendix
which would have been easily relieved earlier
by appendectomy.
The sudden intraperitoneal rupture of an
appendiceal abscess can of course give a very
similar picture to the above. Here there are the
usual findings of an appendiceal abscess with
tenderness and rigidity together with the
presence of a mass in the right lower quad-
rant with, evidence of localized peritonitis. If
there is rupture of this abscess with extension
info the general peritoneal cavity, generalized
peritonitis results. The differential diagnosis
should not cause a great deal of difficulty,
but the diagnosis can be aided by doing a
rectal examination. The presence of a mass in
the right lower quadrant on rectal examina-
tion together with fullness, induration and
possible softening in the cul-de-sac points to-
ward the diagnosis of ruptured appendiceal
abscess.
Salpingitis — Occasionally acute salpingitis
complicated by rupture of a tubo-ovarion ab-
scess may cause confusion in differentiating
it from an appendiceal abscess. However, the
pain is usually localized in the pelvis, the
leukocyte count is higher than in appendi-
citis, and the febrile reaction is usually much
higher in the earlier stages than in appendi-
ceal complications. A careful pelvic examina-
tion will usually reveal the difference in the
two conditions. A tender palpable mass at-
tached to the right side of the uterus in the
region of the broad ligament is usually in-
dicative of a tubo-ovarian abscess.
333
334
Abdominal Catastrophes — Martin and Street
June, 1945
Cholecystitis — Infectious cholecystitis with-
out obstruction is usually of insidious onset
and does not constitute an acute abdominal
emergency as it is relatively free from the
danger of rupture. On the other hand the
acute obstructive type of cholecystitis is an
emergency and 95 per cent of all gangrene and
perforations occur in the acutely infected and
obstructed gallbladder.1 A patient with acute
obstructive cholecystitis usually presents a
history of a rather sudden onset of colicky
pain in the upper right quadrant which later
becomes more severe and constant and may be
referred to the interscapular region of the
back. Nausea is rather severe with marked
vomiting. There may be a history of previous
gallbladder colic with or without jaundice.
When perforation occurs there is a sudden
flooding of the peritoneal cavity with infected
bile, which at first produces a chemical peri-
tonitis followed in eight to twelve hours by
a bacterial peritonitis. Examination usually
reveals the patient in shock or semi-shock. The
skin is cold and clammy, the pulse is rapid
and the blood pressure low. Jaundice may or
may not be present. There is board-like rigid-
ity of the abdomen and a mass can often
be palpated in the upper right quadrant un-
less it is obscured by rigidity or obesity. Dis-
tention may be present if ileus has occurred
from the peritonitis. Operation of course is im-
perative but should be delayed until some
restitution has been accomplished by the giv-
ing of glucose together with plasma or blood.
Acute Pancreatitis — Acute pancreatitis is an
infrequent cause of acute abdominal disease,
being responsible for less than 1 per cent of
cases.1 This may mimic the findings of perfor-
ated gastric or duodenal ulcers, gangrenous and
perforated cholecystitis and those of intestinal
obstruction. Pathologically it may present an
acute pancreatic edema, acute pancreatic ne-
crosis, acute hemorrhagic pancreatitis and
pancreatic abscesses, which are all phases of
the same process. In general these patients
might suggest a ruptured peptic ulcer, but
they lack the board-like rigidity. They might
suggest an acute gallbladder except for the
fact that they are too ill, or an acute throm-
bosis but for the normal pulse rate and blood
pressure. Certain types of strangulated ob-
structions might make differential diagnoses
difficult as acute pancreatitis must also be ac-
companied by a silent abdomen.13 The usual
history is a sudden acute onset of severe epi-
gastric pain accompanied by nausea and per-
sistent vomiting. The vomiting is usually so
severe that it is not alleviated by morphine
or by gastric suction as is the usual case of
ruptured peptic ulcer. In the early stages the
patient may have no fever, a normal blood
pressure, and a slow pulse. Tenderness in the
epigastrium may be very slight in the early
stages. Recently interest has been shown in
regard to x-ray diagnoses of acute pancreatitis.
The x-ray findings suggestive of acute pan-
creatitis consist of: (1) tender tumefaction
of the pancreas found during fluoroscopy, (2)
changes in the stomach and duodenum, and
(3) evidence of localized or generalized ileus.13
The spot film may show some widening of the
region between the gas bubble in the stomach
and the gas in the tranverse colon. Pathognom-
onic consideration is a loss or flattening of
the greater curvature of the stomach found
on fluoroscopy after digestion of barium. This
is caused by displacement of the stomach due
to edema or hemorrhagic cysts of the pancreas.
Until recent years acute pancreatitis was con-
sidered an indication for immediate operation,
the indications being to relieve tension, to stop
hemorrhage and leakage and to afford drain-
age. At the present time most writers contend
that the operation is best deferred until the
acute pancreatic symptoms subside, however
due to the difficulty of correctly diagnosing
the condition there probably would be many
ruptured peptic ulcers diagnosed as acute
pancreatitis by the average surgeon and hence
delay would in the majority of cases mean the
death of the patient.19
Diverticulitis — Diverticulitis usually occurs
in one of two locations, either in the small in-
testines as an inflammation of a Meckel’s di-
verticulum, or in the descending or sigmoid
colon from inflammation of diverticulae in
this region. Meckel’s diverticulitis may mani-
fest itself in two ways, either as massive
hemorrhage most often seen in children, or
as a diverticulitis which mimics a midline or
left sided appendicitis.11 A Meckel’s diverti-
culum is usually lined with gastric mucosa in
which a peptic ulcer may occur resulting in
either perforation or hemorrhage. Massive rec-
tal hemorrhage occurring in infants and chil-
dren in which other causes of bleeding have
been ruled out should be subjected to a laparo-
tomy in view of finding a Meckel’s diverticulum
from which hemorrhage is occurring.
Acute Meckel’s diverticulitis usually cannot
be distinguished from acute appendicitis except
June, 1945
Abdominal Catastrophes — Martin and Street
335
by its location and most often must be proved
by laparotomy.
Diverticulae of the colon may occur in any
part, however, 60 to 85 per cent are found in
the descending colon and sigmoid.is It is in this
area that almost all of the complications re-
quiring operative intervention rise. The most
serious but least frequent complication of di-
verticulitis is a sudden perforation into the
peritoneal cavity causing generalized periton-
itis. This is rare however, perforation and ab-
scess formation being much more common, be-
cause peridivertitulitis usually walls off the
impending perforation by fixation of the sur-
rounding viscera to the inflammatory area.
OBSTRUCTION
Intestinal Obstruction — Intestinal obstruc-
tion can be primarily divided into two classes:
large bowel and small bowel. Large bowel ob-
struction is usually insidious in onset and
characterized by increasing constipation and
gradually increasing distention. Nausea, vomit-
ing and even pain may be late manifestations.
The most common etiological factors are car-
cinoma and inflammation. The diagnosis is
usually relatively simple. The x-ray findings to-
gether with a careful digital and sigmoido-
scopic examination will usually cinch the diag-
nosis. There is one condition however which
produces an acute abdominal emergency. This
is volvulus of the sigmoid. In this condition
there is an abnormally long sigmoidal loop
with a long mesentery. A sudden twisting of
the bowel upon itself produces a complete ob-
struction of the closed loop variety with rapid
embarrassment of the blood supply. In addition
to the usual findings of large gut obstruction,
the x-ray is quite characteristic showing a
localized enormously distended sigmoid. Early
operation is imperative to prevent gangrene
and perforation.
Small bowel obstruction may be divided into
two etiological factors, (1) intrinsic and (2)
extrinsic. The intrinsic causes of intestinal ob-
struction are usually due to foreign bodies
such as gall stones, hair balls, persimmon be-
zoars or boluses of worms in children.! o Ob-
struction may be also caused by tumors aris-
ing from the bowel wall but this is relatively
rare in small intestines.
The extrinsic causes of small bowel ob-
struction are much more important and are
usually due either to hernia or adhesions. In-
carcerated or strangulated hernias are the
most frequent causes of intestinal obstruction
and may fee of two types, either external
or internal. The diagnosis of intestinal ob-
struction from external hernia is usually ob-
vious either from the history or from the phy-
sical findings of a hard indurated mass in
either the inguinal, femoral or ventral regions.
However, there is one type of particular im-
portance and this is a Richter’s hernia usually
of the femoral variety. 5 Here only part of the
wall of the bowel is caught in the hernia. The
obstruction is incomplete and the symptoms
are usually of mild character and unless a
careful examination of the hernial orifice is
done the diagnosis may not become apparent
until the perforation and peritonitis has oc-
curred.
Internal hernias present an entirely different
problem and are probably one of the most
difficult diagnoses to make in the acute ab-
domen. Fortunately this condition is rare but
should be kept in mind when making a differ-
ential diagnosis. The most common causes for
internal hernia are herniation in the region
of the paracecal fossa, the paraduodenal fossa,
rent in the mesentery! or omentum and dia-
phragmatic hernia. The patient with an inter-
nal hernia may complain of vague pains and
discomfort for a varying length of time until
there is a sudden twisting or incarceration of
the hernial mass. When this .occurs the ef-
fects are disastrous because of the large a-
mount of bowel involved in the hernia. The
sudden disturbance to the blood supply of this
long length of bowel produces a truly fulmi-
nating abdominal catastrophe. These patients
usually complain of severe abdominal pain
which is followed in a short time by marked
shock. Thrombosis of the mesenteric vessels
occurs relatively early unless operative reduc-
tion is accomplished. The diagnosis is par-
ticularly difficult but is characterized by se-
vere colicky pain, marked shock with rapid
distention followed by rigidity and signs of
peritonitis as thrombosis with gangrene pro-
gresses. There may be vomiting of blood or
bloody mucus in the stool. The blood count
is usually normal until the later stages of
peritonitis occur. An erect x-ray plate of the
abdomen shows distention and fluid levels.
Unless operation is done early the prognosis
is usually hopeless.
Adhesions have long been known as a com-
mon cause of intestinal obstruction and most
often follow operations in which infection was
a factor, but may also be due to faulty sur-
gical technic. The failure to reperitonealize
raw surfaces or properly close the peritoneum
T33:
336 Abdominal Catastrophes
O j- ; ; -i-J * ' - X~ - ■ ■ .
;.rj of the wound may result in adhesions. The
picture of intestinal obstruction occurring in
a patient with an abdominal scar and a history
of peritonitis or a wound infection will most
often be found to be due to adhesions.
Intussusception — Intussusception is charac-
terized by certain findings which make the
diagnosis relatively easy, mainly age incidents,
bloody stools, and a palpable mass.3 It occurs
most often in children under two years of age,
usually between the ages of three and nine
months. The onset is sudden and consists of
severe cramping pains which cause the child
to double up and scream with agony. This is
followed by a remission in which the patient
may even go tb sleep. One or two hours after
onset the child begins passing bloody mucus in
the stools and the tumor can be felt along the
course of the colon. Distention and persistent
vomiting occur relatively late. In question-
able cases a barium enema under fluoroscopic
observation will prove the diagnosis. Rarely
intussusception occurs in adults with tumors
of the bowel wall.
Volvulus — Volvulus of the intestinal tract
fortunately is a rare occurrence. It may oc-
cur at any age period from the newborn to
the aged. Volvulus occurring in the early dec-
ades of life is usually based on congenital de-
fects such as failure of rotation of the intes-
tines or incomplete fixation of the mesentery.
Volvulus of the small intestine or cecum oc-
curs most often in children while volvulus of
the sigmoid occurs in the older age groups. Ob-
struction of the small intestine by volvulus
gives rise usually to copious and frequent vom-
iting. The presence of a mass in the mid abdo-
men accompanied by signs of intestinal obstruc.
tion attended by tenderness should suggest
the possibility of volvulus. 20 The scout x-ray
film is usually of great value in revealing a
markedly distended loop of bowel compatible
with obstruction of the closed loop variety.
In general the diagnosis of intestinal ob-
struction is based upon one or more of the fol-
lowing findings. Colicky abdominal pain accom-
panied by hyperhyperistaltic rushes, nausea,
vomiting, obstipation, and distention, together
with an absence of fever and leukocytosis in
the early stages, and accompanied by x-ray
evidence of fluid levels and gaseous distention.
When confronted with evidence of intestinal
obstruction it is well to remember, that in
children intussusception is the most common
cause. In the middle ages hernia and ad-
hesion are most frequent and in older pa-
. SjZIjT..
—Martin and Street June, 1945
tients carcinoma is usually the etiological fac-
tor.
Mesenteric Thrombosis — Mesenteric throm-
bosis and embolism are rarely recognized pre-
operatively. The important thing to recognize
is that a serious surgical lesion is present that
demands opening the abdomen. It occurs most
often in persons between the age-s of 30 and
75 in whom there i§r,a history of myocarditis,
endocarditis,.- pr arteriosclerosis. The superior
mesenteric artery is most frequently involved,
rarely the inferior mesenteric. The usual mani-
festations of disease are the sudden onset of
severe acute abdominal pain, vomiting, and
diarrhea. The stools and vomitus occasionally
contain blood. Shock is generally manifested
and the pulse is frequently rapid and irregu-
lar.i6 The temperature is normal or subnormal
but occasionally there is fever even in the
early stages. Distention of the abdomen is
progressive though not extreme. An abdominal
tumor may be observed in a small percentage
of cases. The pain is distinguished from that of
intestinal obstruction in that it is not colicky
in type but is continuous and severe.
Twisted Ovarian Cyst — An ovarian cyst
whose pedicle becomes twisted is character-
ized by an abrupt onset of violent abdominal
pain accompanied by nausea and vomiting to-
gether with evidence of shock. The shock is
caused by the excruciating pain. The abdomi-
nal wall becomes rigid and tender and often
a tumor can be seen in the pelvic region
which increases in size. The diagnosis is aided
by feeling an exquisitely tender cystic mass
on bimanual palpation.
PERFORATION
Perforated Gastric and Duodenal Ulcers —
The patient with a ruptured peptic ulcer will
often give a history compatible with a gastric
or duodenal ulcer, however occasionally rup-
ture takes place in patients with a so-called
silent ulcer without any prodromal symptoms.
The onset is abrupt and is sometimes accom-
panied by a history of trauma to the epigas-
trium, sudden straining or lifting of a heavy
object. The pain is excruciating and is at first
confined to the pyloric region of the stomach
but later spreads toward the right lower quad-
rant as the acid gastric chyme flows down
the right colic gutter. Later the pain becomes
generalized all over the abdomen and is ac-
companied by board-like rigidity, nausea, and
persistent vomiting. Shock may be present in
varying degrees. The patient is usually found
June, 1845
Abdominall Catastrophes — Martin and Street
337
lying perfectly still on the left side with the
thighs flexed on the abdomen. He objects to
being moved as he is in excruciating pain.
This is in contradistinction to the patient with
a urinary colic who rolls and writhes with his
pain. In the early stages the temperature is
normal or subnormal and there is no leuko-
cytosis present. The diagnosis is confined by
finding air under the diaphragm in the erect
plate of the abdomen. If the patient is too ill
to sit up an AP view taken in the left lateral
decubitus position will reveal air between the
right lobe of the liver and the right costal
margin.
Typhoid Ulcer — Perforation of typhoid ulcer
is by far the most important, the most dread-
ed, the most fatal complication fever. In the
majority of instances it occurs during the
third week in the severe cases, particularly with
those associated with diarrhea, distention, and
hemorrhage. The most common site of per-
foration is the lower portion of the ilium. As
a rule it is single, but may be multiple. The
most important single symptom is a sudden
sharp pain referred to the right lower quad-
rant. Shortly after the onset of pain a de-
cided change is observed in the condition of
the patient. There is nausea, vomiting, and
increase in the pulse rate and the temperature
falls to be followed by a rise. There is local
rigidity of the abdominal muscles, particularly
near the site of perforation, and after a short
period the entire abdomen becomes markedly
rigid. If gas escapes into the abdominal cavity
the liver dullness becomes obliterated and
pneumoperitoneum may be demonstrated by
x-ray. In a patient presenting symptoms of
such a lesion it is much better to advise an
exploratory laparotomy rather than to delay
too long for the development of a perfectly
typical picture. Even under the most favor-
able conditions the mortality is exceptionally
high.
HEMORRHAGE
Bleeding Ulcers — Hemorrhage from a peptic
ulcer requiring surgical intervention occurs
usually in patients past forty years of age
in whom arteriosclerosis is a factor. Bleeding
in younger patients usually responds to con-
servative treatment. When massive hemor-
rhage occurs these patients vomit copious
amounts of blood and pass frequent massive
tarry stools. Shock is often severe but is de-
pendent on the amount of blood loss. Anemia
is apparent as paleness of the mucous mem-
branes, colorless nail beds, and a marked drop
in the red cell count. The diagnosis is not often
difficult as the patient usually gives a history
of peptic ulcer, often with previous hemor-
rhages. In the differential diagnosis rupture
of an esophageal varix would have to be con-
sidered but these patients usually have other
findings compatible with cirrhosis of the liver.
Ruptured Extrauterine Pregnancy — Rupture
of an extrauterine pregnancy is usually pre-
ceded with the history of missing one or two
periods followed by a slight spotting of vaginal
blood. With the onset of rupture the patient
often complains of a desire to void or defecate
and may often go to the bathroom and faint.
As the hemorrhage progresses the patient pre-
sents all the signs and symptoms of acute
blood loss accompanied by shock, paleness,
rapid thready pulse, cold clammy skin and evi-
dence of severe anemia. There is pain in the
lower abdomen with tenderness over the pelvic
region. There may be pain referred to the
shoulder region. Vaginal examinations wiil
usually reveal moderate softening of the cer-
vix with other early signs of pregnancy such
as increased blueness of the vaginal wall and
softening of the lower uterine segment. The
uterus may be slightly enlarged. There is of-
ten a bloody flow from the cervix, sometimes
with passage of clots or decidual membrane.
Palpation reveals marked tenderness on man-
ipulation of the uterus, the mass may be
palpated in one of the adnexa which is ex-
quisitely tender, and the cul-de-sac is often
tender and bulging. In cases where the diag-
nosis is not clear further information may be
obtained during a vaginal examination under
anesthesia. At this time an adnexal mass
which has previously been missed because of
abdominal pain and rigidity can often be felt
when relaxation occurs under anesthesia. The
diagnosis can often be aided by doing a cul-
de-sac puncture with an aspirating needle. If
bright red blood is obtained the diagnosis is
confirmed.
TRAUMA
Traumatic Injuries to the Abdomen — Trau-
matic injuries to the abdomen must primarily
be divided into penetrating and non-penetrat-
ing. If a penetrating open wound of the ab-
domen is present then one must decide whether
the injury is extra-peritoneal or intra-peri-
toneal. If extra-peritoneal injury is present
the prognosis is good and the treatment con-
sists only of local treatment of the wound.2!-1 6
338
Abdominall Catastrophes — Martin and Street
June, 1945
However, if penetration of the peritoneal cavi-
ty has occurred then exploratory laparotomy
is almost always indicated. is In attempting to
determine whether a wound has penetrated
the peritoneal cavity or not, several procedures
may be helpful, the simplest probably is direct
surgical exploration of the wound to determine
whether the peritoneum has been injured. If
the wound has been caused by a bullet, the
x-ray is of value if there is no through and
through wound. If a point of entrance is pres-
ent but no point of exit, the x-ray or fluoro-
scope will reveal the site of the missile and
allow some speculation as to the possible
course of the bullet and the viscera injured.
An erect plate of the abdomen will also reveal
the presence of air under the diaphragm if
there has been rupture of the hollow viscera.
Generalized abdominal tenderness, rigidity,
marked shock or evidence of blood loss are
usually indicative of intra-abdominal injury. Of
course, if evisceration is present the diagnosis
is obvious.
Non-penetrating or blunt trauma to the ab-
domen presents a more difficult diagnostic
problem. A decision must be made as to
whether there is an intra-abdominal ruptured
viscus or hemorrhage from torn mesenteric
vessels. If intra-abdominal injury is present
these patients usually complain of severe ab-
dominal pain. Tenderness and rigidity is usual-
ly marked and shock is often the predominat-
ing symptom. There may be vomiting of blood
or passage of blood per rectum if the intestine
is injured.17 Trauma to the kidney or bladder
is usually manifested in the form of hema-
turia. The erect x-ray plate of the abdomen
may reveal air under the diaphragm if there
has been rupture of a gas-filled hollow vis-
cus.1 4 Rupture of the spleen is characterized
by marked pain in the left upper quadrant and
tenderness over the twelfth rib posteriorly.
Shock is usually severe and there may be
shifting dullness in the abdomen indicative of
a blood-filled peritoneal cavity. Rupture of the
liver usually produces a similar picture but the
most marked findings are confined to the right
upper quadrant. Rupture of the intestines is
usually characterized by vomiting of blood or
passing of blood in the feces together with
evidence of early peritonitis and marked ten-
derness and rigidity. Rupture of the bladder is
characterized by hematuria and may be con-
firmed by the injection of sodium iodide into
the’ bladder and the taking of an x-ray pic-
ture. If there is any reasonable doubt as to
whether there is intra-abdominal injury or not
the best policy is probably to explore the ab-
domen rather than wait for more definite
signs to appear.
EXTRA-ABDOMINAL CONDITIONS
Certain extra-abdominal conditions may so
closely simulate symptoms of the acute ab-
domen that often an accurate diagnosis is al-
most impossible, however, a carefully taken
history and a complete physical examination
will usually lead one toward the correct diag-
nosis.
Coronary Occlusion — Coronary disease is
particularly likely to be confused with upper
abdominal lesions such as cholecystitis, per-
forated peptic ulcer and pancreatitis in that
it may manifest itself as severe abdominal
pain, nausea, vomiting, fever and leukocytos-
is.15 A careful examination however usually
will reveal evidence of coronary disease to-
gether with the fact that rigidity is usually
slight or absent and there is no increase in
pain on making pressure over the affected area
in the abdomen. Signs of peritoneal irritation
are absent in that there is no rebound tender-
ness or referred pain.
Pulmonary Conditions — Early pneumonia is
often confused with acute intra-abdominal con-
ditions, however, a careful examination of the
chest will reveal a true diagnosis together with
the fact that leukocytosis is marked, the
febrile reaction greater, and there is a lack
of peritoneal irritation.
Spontaneous pneumothorax may occasional-
ly cause confusion but in this condition there
is a normal temperature, the leukocyte count
is not elevated and the typical chest findings
together with an x-ray picture should lead to
the correct diagnosis.
Renal lesions, especially those of the right
side, are often confused with appendicitis.
Renal infection with fever, leukocytosis and
pain in the right side is often confused with
a suppurative appendix. However, the pain
is usually posterior over the twelfth rib and
the finding of pus on urinalysis should avoid
confusion. Renal colic may simulate an acute
abdominal condition but the fact that the
pain radiates down the loin toward the testicle
together with the findings of red blood cells
and hemoglobin in the urine should aid in
the differential diagnosis. Often a flat x-ray
of the genito-urinary tract will reveal the
presence of calculi. Trauma to the kidney
must often be distinguished from intra-ab-
June, 1945
Abdominal Catastrophes — Martin and Street
339
dominal injuries. Since renal trauma is often
treated conservatively it must be differentiat-
ed from intraperitoneal lesions which require
a laparotomy. Characteristic findings are
gross hematuria together with fullness and
tenderness in the costo-vertebral angle.
Cerebrospinal — Certain diseases of the cere-
brospinal system often cause confusion with
acute abdominal diseases. The gastric crisis
of tabes dorsalis may seem to counterfeit the
acute abdomen. However, shock is absent, the
temperature does not rise, the pulse may in-
crease in frequency but the volume remains
good and possibly most important, the ab-
dominal wall is not rigid in the intervals of
pain of a gastric crisis. A careful investiga-
tion of the pupillary and tendon reflexes will
facilitate the making of a correct diganosis.
SUMMARY
Some of the more frequent causes
of abdominal catastrophe have been dis-
cussed under the heading of inflammation, ob-
struction, perforation, hemorrhage and trau-
ma together with the more common extra-ab-
dominal conditions which simulate the acute
abdomen. Points in the differential diagnosis
have been stressed and laboratory aids in diag-
nosis presented.
COMMENT
It is granted that often an exact
diagnosis can not be made. One must decide
however whether an acute abdomen exists and
if laparotomy is indicated. Only through a
rational consideration of the differential diag-
nosis can an intelligent decision be made and
the proper surgical procedure planned.
BIBLIOGRAPHY
1. Abell, Irvin: Acute Abdominal Emergencies,
Southern Medical Journal. 31:39. 1938.
2. Adams, William E., and Olney, Mary M. : Mesen-
teric Lymphadenitis and the Acute Abdomen,
Report of Thirteen Cases, Annals of Surgery,
107:395, .938.
3. Cope, Zachery: The Early Diagnosis of the Acute
Abdomen, Oxford University Press, 1937.
4. Cutler, George D., and Scott, H. William: Trans-
mesenteric Hernia, Surgery, Gynecology7 and Ob-
stetrics, 79:509, .944.
5. Eliason, Eldridge, L : Early Diagnosis in Ab-
dominal Surgery, American Journal of Surgery,
31:275, 1936.
6. Ficarra, Bernard J. : Mesenteric Vascular Occlu-
sion, The American Journal of Surgery, 66:168,
1944.
7. Finney, J. M. T. : The Acute Abdomen, New Or-
leans Medical and Surgical Journal, 87:589, 1935.
8. Gordon-Taylor, Gordon: The Problem of Surgery
in Total War, Surgery. Gynecology and Obstet-
rics, 74:375, 1942.
9. Gucrry, LeGrand: Surgical Judgment in the Ap-
proach to the Acute Abdomen. Annals of Surgery,
98:922, 1933.
10. Kirby, F. J. : Early Recognition of Acute Abdomi-
nal Diseases, Southern Medical Journal, 23:5.2,
1930.
11. Ladd, William E„ and Gross, Robert E. : Ab-
dominal Surgery of Infancy and Childhood, W.
B. Saunders Company, Philadelphia, 1941.
12. Mann. Bernard: Acute Surgical Conditions in the
Abdomen in Gynecology, Medical Record, 132:26.
1930.
13. Metheny, David, Roberts, Edward W.. and Stran-
ahan, Allan: Acute Pancreatitis With Special
Reference to X-ray Diagnosis, Surgery. Gynecol-
ogy and Obstetrics, 79:504, 1944.
14. Mulhollond, John H., Bailey, Fred W., and Storck.
Ambrose H. : Abdominal Traumas, Panel Dis-
cussion, International Abstract of Surgery, 73:-
299, 1941, (October).
15. Ochsner, Alton, and Murray, Samuel D. : Pitfalls
in the Diagnosis of Acute Abdominal Conditions,
American Journal of Surgery, 41:341, 1938.
16. Sherman, William O’Neill: Abdominal Injuries,
Surgery, Gynecology and Obstetrics, 58:507. 1934.
17. Storck. Ambrose H. : Diagnosis in Abdominal
Trauma. American Journal of Surgery, 56:21, 1942.
18. Thompson, George F., and Fox. Paul F. : Per-
forated Solitary Diverticulum of the Transverse
Colon. The American Journal of Surgery, 66:280,
1944.
19. Vaughn. A. M. : The Acute Abdomen The Ameri-
can Journal of Surgery, 47:602, 1940.
20. Wangensteen. Owen H. : Intestinal Obstruction,
Charles C. Thomas, Springfield, Illinois, 1942.
21. Wright, Louis T.. and Wilkinson, Robert S. : and
Gaster, Joseph L. : Penetrating Stab Wounds of
the Abdominal Wall. Surgery, 6:241. 1939.
The aardvark is an ant-eater of Africa —
singular and queer in appearance and habit,
a long, narrow head, a long tapering tail with-
out hair. It burrows into an ant hill and comes
out at night looking for a new and better hill
where ants erect a village. It suckles its young.
Its name means “earth pig.”
Nature is prolific in its species, a wonder-
ment to mankind.
Penicillin and Its Use in Some Infected Surgical
Cases* v ,, ,
■i '
V. B. PHILPOT, M.D., F.A.C.S
Tupelo, Miss.
To begin with, I think I am correct in
stating that there has never been a drug
in the history of medicine, certainly not
in the last generation, which is so effective
as a bacteriostatic agent on many important
pathological bacteria as penicillin. In fact, dur-
ing the last two years this agent has been
discussed and written about more than all
other remedial agents combined.
HISTORY
I shall not attempt to give you much his-
tory concerning this new drug, but the fol-
lowing brief review from an editorial in the
British Medical Journal published last year
may be interesting. It seems apparent that in
1877, Pasteur and! Joubert were the first to
observe that cultures of anthrax ceased to
grow when contaminated with air bacteria;
and was the first observance, according to
Florey, that a substance produced by one or-
ganism is capable of arresting the growth of
another.
Fleming of England, in 1929, may be con-
sidered the latter day, or real, discoverer of
penicillin by noting a conspicuous inhibition of
growth in a colony of staphylococcus con-
taminated by mold, he subcultured the mold in
broth and found that a strong antibiotic, non-
toxic to animals, passed into the broth from
the mold. The mold was later identified by
Thom in this country as Penicillium notatum,
and Fleming designated the antibiotic agent
“penicillin.” He found that penicillin inhibited
the test tube growth of many gram positive
bacteria known to be highly pathogenic to
man. Fleming and his associates abandoned
further study of the agent. It was used only
for laboratory procedures, until 1941.
The clear-cut proof of the clinical useful-
ness of this drug, its essay and dosage, as
well as the mode of its excretion from the
body, are credited to Howard Florey and his
associates at Oxford, England, in 1938.
In this same issue lof the British Medical
Journal , the editor also generously gives (credit
to American pharmaceutical and biological
*Read at the quarterly meeting- of the Northeast
Mississippi Thirteen Counties Medical Society, Colum-
bus, Mississippi, March 13, 1945.
houses and their research workers in the
large scale production of this drug.
DOSAGE
There is considerable difference of opinion
concerning the dosage, amount of drug neces-
sary, and mode of administration; but accord-
ing to the opinion of a majority of those
using this drug, as well as the experience
of those having done research with it for
many months, the drug is eliminated rapidly
by the kidneys and it is necessary to adminis-
ter it as often as every three hours either
intravenously or intramuscularly; or, what is
still more preferable, to give it intravenously
in a continuous drip.
I think the experience of most users has
been to give about 20,000 units every three
hours, until the infection for which it is given
is under control, or 100,000 units in a con-
tinuous drip intravenously in thirty hours.
Just how long the drug should be given to a
patient depends on the area and virulence of
the infection, and the length of time necessary
to overcome this infection. Generally speak-
ing, the time runs from thirty hours to eight
or ten days, and the amount ranges from
100,000 to a million units.
In addition to the intravenous and intra-
muscularly methods of administration, it is
frequently given intrathoracically, intraspinal-
ly, intra-articularly and applied locally. I
have had no experience, however, with any
method except the intravenous and intra-
muscular methods of administration, it is
scarcity of the drug in civilian practice.
SUSCEPTIBLE AND INSUSCEPTIBLE
BACTERIA
There is a great group of bacteria suscep-
tible to penicillin and another group insuscep-
tible to this drug. The following table from
an article by Herrell, Nichols and Heilman
lists the susceptible and insusceptible ones:
Susceptible Organisms
Diplococcus pneumonia
Streptococcus pyogenes
Streptococcus salivarius
Microaerophilic streptococci
Staphylococcus aureus
Staphylococcus albus (some strains)
340
June, 1945
Penicillin — Philpot
341
mn
&
<6T&$
>a.n fcjpow
Mm :L
3 V <;
i/3-
Neisseria gonorrhoeae
Neisseria intracellularis
i n Actinomyces bo vis
rtx bacillus anthraci>3
•~i bacillus anthracis
bacillus subtilis
Clostridium botulinum
Clostridium tetani
Clostridium perfringens (welchii)
Corynebacterium diphtheria^
Vibrio comma
J • cv; -
Micrococci
Streptobacillus moniliformis
Borrelia novyi (spirochete of relapsing
fever
Treponema pallidum
Leptospira icterohaemorrhagiae
Spirillum minus
psittacosis virus
Ornithodorus virus
Insusceptible Organisms
Eberthella typhosa
Salmonella paratyphi
(Salmonella enteritidis
Shigella dysenteriae
Proteus vulgaris
Pseudomonas aeruginosa (bacillus pyo-
cyaneus)
Pseudomonas fluorescens
Serratia marescens (bacillus prodigiosus)
dlebsiella pneumonia
Haemophilus influenzae
Escherichia coli
Staphylococcus albus (some strains)
Micrococcus albus (some strains)
Monilia albicans
Monila Candida
Monilia krusei
Blastomyces
Mycobacterium tuberculosis
Streptococcus faecalis
Brucella melitensis
Plasmodium vivax
Toxoplasma
USES IN CIVILIAN PRACTICE
afrrwt ' c,-*
No, in order that a little clearer conception
may be given as to the uses of penicillin over
sulfonamides, I shall quote from a paper by
Francis G. Blake, New Haven, Connecticut,
read at the American Medical Association,
which I had the privilege of listening to last
June:
The infections which are curable or, if not
cured, favorably modified by the chemothera-
peutic agents under discussion may be divided
three groups with respect to etiology:
..k* 1. Those in which both the sulfonamides
penicillin ' are more or less effective,
1 . > though no^' necessarily equally so, namely,
certain gram positive and gram negative coccic
infections: hemolytic streptococcus-; * pneumo-
®ai ^cocfms, staplfylbcoccus, streptococcus-’-viridans,
-^ffingoeoccus and gonococcus. rlr\r-
2. Those in which the sulfonamides are
of value but not penicillin ; namely, gram nega-
tive bacillary ' infections such as those caused
by the colon bacillus, dysehtery bacilli, hemo-
philus influenzae, Friedlander’s bacillus and
Ducrey’s bacillus.
3. Those in which penicillin is of value
but not the sulfonamides ; namely, syphilis,
yaws and possibly other spirochetal infection
and those due to the Clostridia — gas gangrene.
Blake also concludes that in the less severe
hemolytic streptococcic infections in which
there is tissue invasion without suppuration,
necrosis or bacteremia, such as erysipelas or
lymphangitis, the sulfonamides are ordinarily
sufficiently effective to be indicated as the
drug of choice, if for no other reason than
because of simplicity of administration. The
same may be said of the milder upper respira-
tory mucous membrane infections, such as
tonsillitis or pharyngitis, although the real
value of the sulfonamides in these infections
is still debatable.
In the more severe hemolytic streptococcic
infections with suppuration or necrosis with
or without bacterium penicillin appears to be
much more effective and, consequently, the
drug of choice. It often succeeds in bringing
about a cure when the sulfonamides have
failed . Included in this group are severe cellu-
litis, mastoiditis with or without intracranial
complications, meningits, pneumonia empyema,
pericarditis, endocarditis, peritonitis, puerperal
sepsis, osteomyelitis, suppurative arthritis and
infected wounds.
Also in the two important gram negative
coccic infections — meningococcic and gono-
coccic-penicillin is far more effective, as well
as in ophthalmia, endocarditis and prostatitis.
USES IN WARFARE
In the January 27 issue of the J.A.M.A.
on the editorial page, is a brief review of
a symposium on penicillin in warfare from
the July, 1944, issue of the British Journal of
Surgery. I now give you a review of this re-
view from Major General L. T. Ross, Florey
and Jennings, Lieut. Col. Jeffery, Lieut. Col.
342
Penicillin — Philpot
June, 1945
Bentley, Lieut. Col. Brown, Furlong and
Clark, D’Abreu, Major Robinson, and Wise,
Pillsbury and Mahoney, which briefly is as
follows :
When a soldier is wounded, frequently long
intervals elapse before definite surgical meas-
ures can be taken. Penicillin is used to bridge
this gap and delay and modify, or prevent,
the development of sepsis, and is found to be
the most powerful antibacterial agent yet
brought into clinical use by completely in-
hibiting the growth of the most sensitive or-
ganisms by its bacteriostatic effect. It is the
least harmful agent to the human organism
yet discovered, and is used many ways; name-
ly, intramuscularly, intravenously for its sys-
temic effect, locally in the wound itself, intra-
articularly, intraspinally and intrathoracical-
ly — in other words, every way possible.
These officers found that the drug has
three main spheres in war surgery: 1) to pre-
vent infection of the wound soon after wound-
ing, 2) to control infection in the first two
weeks, and, 3) to combat sepsis in the later
stages. It is also found that in a consecutive
series of 22 casualties with flesh wounds treat-
ed by early secondary suture with penicillin,
primary healing was obtained in 95 per cent.
That even gas gangrene mortality was cut to
36 per cent with the surgery and antiserum
treatment, and as far as gonorrhea was con-
cerned, they treated a thousand cases of sul-
fonamide resistant gonorrhea with approxi-
mately 95 per cent cure.
PERSONAL USE
One may easily presume that the personal
experience in the use of penicillin with any
one person in civilian practice in this area
would not be very great, if for no other reason
than because of the scarcity of the drug. We
have had only enough of this agent to use
in the very worst cases of infection.
I began using it exactly seven and one-half
months ago and have since used it in thirty-
six cases. Before I report any of these cases,
I emphasize the necessity of proper surgical
or other treatments necessary while penicillin
is being used. We may get some results in in-
fection with penicillin alone, but we will get
far greater results if we do whatever else is
necessary at the time.
For instance: In wounds, take care of the
shock, the proper debridement, cleansing,
hemostasis and suturing; in empyema and
lung abscesses, the proper drainage and irri-
gation of the cavities; in peritonitis and other
abdominal abscesses, either local or general,
the removal of foci of infection, drainage and
the open air treatment of wounds as advo-
cated by our own H. A. Gamble of Greenville.
In fact, when there is pus, the proper pro-
cedure is to drain. In all cases proper syste-
matic treatments — fluids, saline, glucose,
blood transfusions and other adjuncts — should
not be neglected.
The following is a brief report of the thirty-
five cases I have treated, which includes the
diagnosis, operation where necessary and end
results of each case:
Name
Age
Final Diagnosis
Operation
End Results
J. A.
L.
67
Cholecystitis with Stones
Cholecystectomy
Recovery
K. M.
F.
2
Peritonitis from Ruptured
Appendix
Incision and Drainage
of Abdomen
Recovery
H. S.
26
Placenta Praevia with Hem-
orrhage, Potentially Infected
Ceasarean Section
Recovery
A. S.
50
Carcinoma of Cecum — Poten-
tially Infected
Resection of Cecum and
Ascending Colon
Recovery
N. D.
13
Suppurative Appendicitis; Rup-
tured
Appendectomy
Recovery
R. M.
D.
20
Suppurative Appendicitis; Left
Inguinal Hernia
Appendectomy — Repair of Left
Inguinal Hernia Recovery
W. T.
B.
67
Cystocele and Rectocele follow-
ed by Hypostatic Pneumonia
Repair of Cystocele and
Rectocele
Recovery
E. C.
34
Appendiceal Abscess with Gen-
eral Peritonitis
Appendectomy — Drainage
Recovery
June, 1945
Penicillin — Philpot
343
L. C. S.
44
Intestinal Obstruction of Ilium
Liberating Obstruction —
and Part of Duodenum
Enterostomy
Recovery
J. D. U.
56
Fractured Rib — Traumatic
Pneumonia
Recovery
R. S. P.
15
Large Abscess of Appendix,
Appendectomy — Right Salpingo-
Right Tube and Ovary; Rup-
tured— Local Peritonitis
oophrectomy — Drainage
Recovery
J. E. P.
9
Suppurative Appendicitis —
Incision and Drainage of
General Peritonitis
Abdomen
Died
R. S. M.
14
Appendiceal Abscess — Rup-
tured
Appendectomy — Drainage
Recovery
C. F.
37
Acute Suppurative Appendici-
tis
Appendectomy — Drainage
Recovery
C. L.
38
Double Pyosalpinx — Double
Bilateral Salpingo — Oophrectomy —
Ovarian Cysts — Fibroid Uterus
Hysterectomy— Drainage
Recovery
R. K. H.
23
Appendicitis- — Ruptured on
Removal — Abscess on Right
Appendectomy — Right Salpingo-
Tube and Ovary
Oophrectomy
Recovery
E. L.
19
General Peritonitis
Stab Wound a Few Hours Before
Seven Days Delay
Death
Died
J. H.
16
Ruptured Appendix
Appendectomy — Drainage
Recovery
G. F. D.
65
Perforated Duodenal Ulcer
Repair of Duodenal Ulcer
Recovery
L. P.
37
Pneumonia — Phlebitis — Two
Weeks After Appendectomy
Recovering
L. C.
23
Second and Third Degree Burns
of Legs and Lower Half of
Thighs
Recovering
D. M.
25
Second and Third Degree Burns
of Legs and Lower Half of
Thighs
Skin Graft
Recovering
C. C.
35
Third and Fourth Degree Burns
of Entire Body, Thighs and
Legs
*
Died
G. H.
15
Suppurative Appendicitis —
Ruptured — Peritonitis
Appendectomy — Drainage
Recovery
G. F.
9
Appendiceal Abscess — Rup-
tured— Peritonitis
Appendectomy — Drainage
Recovery
H. B.
39
Localized Empyema of Right
Chest
Thoracotomy — Drainage
Recovering
G. C.
36
Double Pyosalpinx
Bilateral Salpingectomy —
Suppurative Appendicitis
Drainage
Recovery
J. W.
3
Cellulitis
Appendectomy
Recovery
J. D. W.
13
Sinusitis
Recovery
B. P.
55
Gonorrhea
Improved
6 Cases
Recovery
(Lantern Slide Demonstration)
The last slides demonstrate
the bacteria
The following slides showing copies of the
above cases will give you some idea of the
temperature and pulse behavior following the
use of penicillin.
present in a few typical cases.
I am indebted to Misses Lucas and Duno-
vant, technicians at the Community Hospital,
at Tupelo, for their drawing of the bacteria.
344
Penicillin — Philpot
June, 1945
-
mmmmm
m 1 Sputum
* t . Burt --- Pelvic Lap
♦» \ }Tgv ' —
f
, / s
"
m!§!«!8§
fsiiifia
I
A. C WWBWBM
Direct Smear: Gram positive Cocci,
Gram positive baolXXl
..
m
. *w> ' "
*
Direct Smear; Positive from Gram
positive Cocci
rfBr
^ m
/ . ■ ■■ w . - > . f,, . a
% f A , ji
• */
# . m ■ *
'•
44' ? '
#
1IIS
g§g -
^ - "v
** .^4 . „ *»
% x jt *
:\K X . '-'?* ? . « \ **##
Culture:
fXVfX ■■/■' X"- ■ : : ' . . ' !
Culture: Pos. from Staphylococcus
Aureus
,
GRAPHIC CHART
Room or
GRAPHIC CHART
June, 1945
Penicillin — Philpot
345
■ ' s
gjpgg
Direct Smear? Gram positive cocci.
Gram negative bacilli
CLARK
Ruptured Appendix
r dk
A w 1
v;
<o
/<>,
/ m
l &
Direct Smear: Positive for Gram positive
cocci and bacilli
Culture! Positive for Staphylococcus
Aureus B-L
GRAPHIC CHART
_Z-?A
346
June, 1945
BURT
M1
' - 4 p<
J\ i'
&/
lisp
]M
/’!
” / Ky / .. '- ": ' !
Direct Smear: Gram positive oooci,
Gram negative bacilli
/
X-XX-.-VwM. .»W*<M*,V,>„AV»W ~ V '•<- -.W
/ 1
- , x V
GRAPHIC CHART
Culture : Balantidium Coll, staphylococcus
LIFE IS LARGELY WHAT WE MAKE IT
John Dale Kempster
Life Surely is a see-saw thing;
We never know just what ’twill bring.
Sometimes it lifts us “high in air”
Where skies are blue, and all is fair;
Sometimes it “bumps” us down to earth
Mid gloomy days of little worth ;
But never mind how dark the clouds
Nor blue the thoughts, that come in crowds,
We know somewhere the sun is shining
And every cloud hath silver lining;
So lift your head, throw out your chest,
Put on a smile and do your best,
Stand firm in will, there’s naught can beat it,
For after all, Life’s what we make it.
Typhus Fever
O. P. STONE, M.D.
Ripley,
There are several reasons why typhus fe-
ver is an appropriate subject for discus-
sion at the present time. One of the chief
reasons is that the prevalence of this disease
has increased gradually in the United States
during the past few years and has shown a
rather marked increase in the state of Missis-
sippi during the past two and one-half years.
It is of importance to note that already ninety-
one cases of typhus fever have been reported
in Mississippi during 1944.
Another reason that typhus fever deserves
some attention and discussion is that many of
our soldier boys are at the present time
fighting in areas where typhus fever occurs
in epidemic form. These boys may soon return
to this state and unless some precautions are
observed they may bring the epidemic form
of typhus to our own communities.
In a discussion of typhus fever one should
observe that there are two forms of the disease
namely, the epidemic and endemic forms. The
epidemic form is seen mainly in Europe where
it has ravaged the population of the Balkan
States and parts of Italy and Russia for gene-
rations, with marked increases in the preva-
lence of the disease during each of the numer-
ous wars that have occurred in this area. Th =
vector of epidemic typhus is the body louse.
Endemic typhus fever, which is the form
seen in the United States, differs from the
epidemic type in that it is a much milder
disease and has a mortality only about one-
third as great. The vector of endemic typhus
is the rat flea. It seems that the type of vector
determines to a great extent the severity of
the disease and this may account for the oc-
currence of two forms of typhus fever.
Typhus fever is an acute specific infectious
disease, occurring in epidemic and endemic
forms. It is characterized by a sudden onset,
maculopapular eruption, toxemia, high fever,
and severe nervous symptoms. The disease
lasts about fourteen days and terminates usual-
ly by crisis. It is transmitted by the body louse
or other insect vector and the convalescent
period is usually prolonged. The exciting cause
of typhus fever is the Rickettsia Prowazeki
*Read at Northeast Mississippi Thirteen Counties
Medical Society, Amory, Miss., Sept. 12, 1944.
Miss.
which is a pleomorphic organism occurring as
minute, paired ovoid bodies, and in filamen-
tous forms. Therefore, it takes the classifica-
tion of a rickettsial disease along with Rocky
Mountain spotted fever, trench fever, and
others. It will be noted that there is always a
marked increase in the prevalence of typhus
fever during wars, famines, and economic dis-
tress when overcrowding, lack of facilities, and
lack of attention to bodily cleanliness predis-
pose to the spread of the disease.
The period of incubation is usually about
twelve days, but variations from eight to four-
teen days are not uncommon. During the lat-
ter days of the incubation period the symp-
toms of weakness, malaise, and slight rise of
temperature may be noted. The actual onset
is usually abrupt with chill, rapid rise of tem-
perature to 103° and mild delirium. The tem-
perature remains high with mild variations for
about two weeks. In cases terminating favor-
ably the temperature declines by rapid lysis
or crisis. Cough, headache, muscular pains,
loss of appetite, and nausea and vomiting are
common symptoms.
In the early stages of the disease the erup-
tion is the most diagnostic physical finding.
However, this usually does not occur until the
third to the fifth day. In contradistinction to
typhoid fever the rash of typhus comes out in
a single crop. These spots are macular in
character at first but may become large pur-
plish splotches as extravasation of blood oc-
curs under the skin. With the onset of the
rash, the signs of toxemia and especially cere-
bral symptoms become more marked and may
even lead to coma. The occurrence of red blood
cells in the urine is not uncommon.
Typhus fever is accompanied by a milk leu-
kocytosis averaging about 12,000 in uncompli-
cated cases.
The Weil-Felix agglutination reaction, per-
formed by using standard cultures of Bacillus
proteus X19, is positive in almost all cases
and either the macroscopic or the microscopic
may be used. This procedure can be done by
the Mississippi iState Laboratory at Jackson
and is used as proof of the diagnosis.
The complications of typhus fever vary in
different localities. In the endemic form the
most common complications are bronchitis,
bronchopneumonia, meningismus, phlebitis, and
348
Typhus Fever — Stone
June, 1945
otitis media. Occasionally such complications
as suppuration of the salivary glands and
gangrene of large areas of skin are seen.
The gross pathological changes as found at
autopsy are not pathognomonic in typhus fe-
ver. The distinctive lesions are microscopic.
The skin shows the petechial rash persisting
after death and may show areas of skin necro-
sis and gangrene. The blood is of dark color
and coagulates slowly. If death occurs during
the first two weeks the spleen may be en-
larged. Areas of bronchitis and bronchopneu-
monia are commonly found in cases terminat-
ing fatally.
Microscopically, the distinctive lesions of
the disease involve the smaller vessels, notably
those of the skin and of the brain, thus ac-
counting for the two most characteristic symp-
toms of the disease — the skin rash and the
central nervous system manifestations. De-
generation and necrosis are noted in the en-
dothelial lining of the vessels succeeded by
formation of thrombi and finally to loss of
continuity of the wall and extravasation of
blood.
The treatment of typhus fever is purely
symptomatic. Good nursing care is known to
affect the mortality rate materially. Absolute
bed rest is essential; precautions should be
taken to prevent the patient, in his delirium,
from doing himself harm. His diet should be
liquid or soft in nature and fluids should be
forced. Constipation should be treated by
enemata and the observation of retention and
need for catheterization should be noted. Mor-
phine and codeine have been .found of dis-
tinct value in controlling restlessness, cough-
ing, and pain. Stimulants such as digitalis,
camphor, and caffeine have their place. Bed
sores should be guarded against by frequent
change of position and by pressure pads.
Especial routine care of the mouth is an ab-
solute necessity.
The prophylaxis of this disease is of especial
importance and may be summed up in the
control of the insect vectors. This may not be
a simple procedure, particularly where numer-
ous cases are being handled. The United States
Army has recently demonstrated that de-
lousing can be effectively accomplished by a
powder insecticide sprayed into the clothing
by small spray guns. This was demonstrated
when they recently deloused 80.000 inhabitants
of Naples, Italy, in a matter of a few hours
to stop an epidemic in that area.
The typhus fever present in Mississippi can
only be controlled through the control of rats.
This can be accomplished by poisoning, trap-
ping, and rat proofing. To be effective, con-
trol efforts must be continuous and wide-
spread. It is well to remember that the rat
acts as a reservoir for the disease and that
more and more of our rats are becoming in-
fected as the disease spreads. Stamp out the
rat and the problem is solved as far as present
information indicates.
There is a polyvalent vaccine for typhus
fever that should be used in exposed areas.
At the present time I believe this vaccine is
not available for civilian use but probably will
be immediately after the war.
It seems that President Truman strikes a
home run almost every time an important mat-
ter is tossed him across the plate. Maybe he
will come out for a Secretary of National
Health. In the health of the people is the
strength of the nation. Surely we should have
a secretary of health in the cabinet. The time
is propitious for the entire medical profession
to make a concerted effort to interest President
Truman and our Congress in this very im-
portant matter. The very large number found
unfit for military service should add power
to this request at this time. Our government,
our medical profession, and our people should
make definite plans to build a citizenship able
to function in a superior way when the life
of our nation is at stake. The building of
health reserves should be the order, mental,
moral, and spiritual.
June, 1945
Editorials
349
The Mississippi Doctor
Published monthly at Booneville, Mississippi
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 187u. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
Official Organ Of '
Mid-South Postgraduate Medical Assembly
Mississippi State Medical Association
W. H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
Mid-South Postgraduate Medical Assembly
Officers :
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M. D Vice-President
El Dorado, Ark.
A. F. Cooper Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis. Tenn.
Editors :
Fay H. Jones, M.D. E. M. Holder, M.D.
C. R. Crutchfield, M. D. C. M. Speck, M.D.
H. King Wade, M. D. F. M. Acree, M.D.
Mississippi State Medical Association
Editor
Lawrence W. Long, M.D.
Associate Editors
T. G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life Building,
Jackson. Mississippi.
It seems to be admitted even by officials
of the American Medical Association that
Mississippi has had one of the very best two-
year medical schools in the United States for
more than forty years. The record the two-
year men from Ole Miss have made on exami-
nations and in practice confirms this general
impression. Mississippi has perhaps the best
public health service in the United states. It
also has an excellent distribution of hospitals
Mississippi is among the lowest states in
death rates from appendicitis, South Carolina
being the lowest and Nevada (which has the
greatest number of beds per population) hav-
ing the highest death rate for appendicitis.
Nevada has bigger hospitals farther apart, the
ideal system according to some, but a high
death rate — “operation a success, but the pa-
tient died.”
§
There are only two places a sound-bodied
doctor should be found now — one in the armed
forces, the other in practice up to his ankles
with his head down.
We deeply regret the death of Dr. A. L.
Blecker of Memphis. In every way he held
high the banner of the profession, able, kind,
and considerate. He was deeply devoted to the
profession and made duty his watchword.
The return of a few thousand soldiers at
this time to aid farming, industry, and business
in general, and with them a few hundred
doctors to fill in the places where the old
doctors are falling in civil combat and where
the people are without medical service, would
be mighty good war economy.
§
Dr. V. B. Harrison of the University of Mis-
sissippi observes that Mississippi is rapidly
becoming a state of children and old people,
the able middle aged seeking their fortunes
in other states. We are quite sure that this
observation is true.
Aside from the challenge such a situation
creates for making our state one of greater
opportunity, there is a special responsibility
resting on the medical profession. In the
specialty of pediatrics in Mississippi much has
been done within the last few years, Dr.
Harvey Garrison being looked upon as a
leader, but we do not have a man in the state
giving special attention to geriatrics. We should
have. In fact the only man we know in this
territory specializing in the practice of the
aged is Dr. Piatt Anderson of Memphis. The
culture, the refinement, the knowledge and
the wisdom of the aged that is going to waste
is enough to enrich our nation. We do not
give due consideration to our aged. If a man
keeps mentally and physically fit he should
be worth more to human society every day
he lives although he lives to be a full hundred.
We also fail to appreciate the loyal sons who
has stayed at home to help build Mississippi.
350
Editorials
June, 1945
In the proceedings of the staff meetings of
the Baptist Hospital of Jackson, Dr. Harvey
F. Garrison reports a case of influenza mem-
ingitis which recovered and which was treated
with sulfadiazine and rabbit haemophilus in-
fluenza serum. We understand this is the only
case of this type which has ever recovered
at the Baptist Hospital.
§
We had a few lines recently from Dr. W. H.
Scudder of Mayersville, the only doctor prac-
ticing in Issaquena County. He is so busy
making history that he did not have time to
furnish the account we desired. Dr. 'Scudder
has been right on the job for more than fifty
years. He has the spirit of a real doctor and
he is patriotic to the nth degree. He is deeply
devoted to duty and in this time of doctor
shortage he is holding the lines just as his
Confederate father did in the War Between
the States. All alone he holds on and stands
at the switch to keep medical service moving
in his county. We appreciate and admire
him and so does the entire profession of the
state. It is his kind which wins wars and makes
a nation secure in peace.
The Future of a Four- Year Medical School
in Mississippi
J. K. AVENT, M.D.,
Grenada, Miss.
President-Elect , Mississippi State Medical
Association
No state will progress farther than the
health of its citizens. The past in the field
of medicine in Mississippi has been relegated
to the archives of history. The future will be
what the physicians, legislators of Mississippi,
and the public as a whole fix as their aim
and duty.
The essential need of Mississippi today is
a four-year medical school and a large state
hospital for clearance of all complicated medi-
cal cases. The most scientific and most
thorough treatment for prevention, cure or al-
leviation of disease — the science of medicine
with lower mortality and lower morbidity — is
taught in medical schools and practiced in
their vicinity. In a modern state hospital, can-
cer, a condition now so terribly neglected in
Mississippi, could be treated with x-ray and
radium, with less pain and the loss of fewer
lives. Poliomyelitis cases could secure hospitali-
zation until complete recovery, instead of the
individuals so afflicted having to go through
life paralyzed. A great laboratory for teach-
ing technicians and conducting bacteriological
work is necessary.
Doctors could send their difficult cases from
all locations in the state, by ambulance, for
consultation. The postgraduate courses which
could be offered to physicians of the state
would be reflected in benefit to the laity. A
home postgraduate course is essential. Some
doctors will not go to other states for post-
graduate work once in ten years, but if it were
available at home, they would go once or
twice a year.
With a large state hospital, the nursing
problem could be solved. The best nurses in
the world are those who graduate from small
hospitals, yet they are not recognized, as
evidenced by the fact that they are not ac-
ceptable to the Army Nurses Corps. Mississippi
nurses could spend part of their time in the
state hospital and solve this essential prob-
lem.
Mississippi boys do not desire to leave our
state for study of medicine in other states,
never to return to their home state, but that
is the fate our state imposes upon them in
not offering adequate hospital, medical school
and internship training. We do not have to
ask any other state for a so-called manufac-
turing plant of doctors. We of Mississippi can
decide our own fate. These boys are the long
staple brains of our colleges. Let Memphis,
New Orleans, Philadelphia, New York, etc.,
consider their assets in Mississippi boys forced
away from home to attend professional schools.
God forbid that it shall continue. We know
our needs; we do not rely upon an out-of-
state man to decide our problem. The medical
profession in Mississippi needs its morale lift-
ed, and that can be accomplished permanently
by a large central hospital and the addition
of two more years of medical school. Among
other benefits is the fact that internal medi-
cine and surgery would be elevated to a higher
level with all other specialties.
We spend millions on highways, schools,
and other public benefits, even hospitalization
of the poor, but fail miserably to finish the
job by obtaining the best scientific skill. The
lives of Mississippians are placed in the palm
of our hand — the hand of the medical pro-
fession of the state. Will you strengthen it,
or will you let it spill these lives? The pri-
mary consideration is not the cost, but the
need, and that need is apparent to the citizen
with foresight now.
June, 1945
Editorials
351
May there be a beautiful sunrise in the
medical career of Mississippi, and God’s eternal
blessings on the sick, the medical personnel,
and the public. With all our wealth and oil,
we cannot go farther than our health. Health
is the gold of our state that will not tarnish.
May we in the near future be broadcasting
medical science to the world from Mississippi,
instead of listening in on stations of other
states.
The question is not when can we attain
this objective, or how. The quickest way is the
best. May our excellent governor call a special
session of the legislature and give promise
to the sick and diseased citizens of Mississippi
that our state may offer the facilities of a
large, modern hospital and that we shall allow
Mississippi’s medical students the opportunity
of completing four years in medicine in their
home state. Let us spend money on men, as
well as on buildings.
Shall we continue to let disease take a high
toll of our loved ones, or shall we conquer it?
Shall Mississippi take her rightful place as a
leader in the medical profession, or shall we
continue to let surrounding states reap the
honor and prestige of medical advancement?
I say, we shall go forward!
EMERGENCY STATE MEDICAL MEETING
1945
The president, Dr. Crawford, the president-
elect, Dr. Avent, the secretary. Dr. Dye, and
the Council are to be complimented in the way
that the Mississippi State Medical meeting was
called and handled under the wartime re-
strictions. The Constitution and By-Laws did
not completely anticipate such an emergency,
and it is hoped that the committee concerned
therewith will study and make recommenda-
tions to our next meeting for such changes as
needed so that there will be no misunderstand-
ing by anyone if ever such an emergency
should again occur. This committee is com-
posed of Dr. D. W. Jones, Dr. W. W. Craw-
ford, and Dr. W. H. Frizell — all are able,
capable and well grounded in the fundamentals
of our medical organization.
Since this was an emergency session, only
the necessary business was transacted. An
open meeting of the Council was held in the
morning which was converted into a meeting
of the House of Delegates, with a quorum
plus proxies from the delegates, which con-
formed to the ruling of the Office of Defense
Transportation so that the meeting consisted
of less than fifty people required to travel to
the meeting. After selection of a nominating
committee, the group adjourned for lunch
at which Governor Thomas L. Bailey made
an inspiring address with emphasis on the
building of a medical center in Jackson. This
seemed to meet the approval of the whole
group. The nominating committee chairman,
Dr. E. C. Parker, reported to the House of
Delegates the nine men required to be nomi-
nated to the governor, from which he will ap-
point three to become members of the State
Board of Health for a term of six years each.
This was an absolute necessity as required by
the laws of Mississippi. The committee then
wisely reported that they recommended the
retention of all officers in status quo until
the next meeting of the State Medical As-
sociation. After certain resolutions were adopt-
ed, the meeting adjourned.
While it was unfortunate that we are en-
gaged in a global war which prevented a regu-
lar meeting of the State Medical Association,
it was coincidental that this absolutely neces-
sary type of meeting was held on V-E Day.
It seems most likely that May of 1946 might
find us under conditions which will allow us
to convene in regular meeting as usual — we
all hope that such will be the condition. It
is also quite significant that these men who
are and have been interested in organized
medicine and its business activities were all
present and interested as usual. Organized medi-
cine is the bulwark and mainstay of the medi-
cal profession as proved by the years. The
sages are required as advisers and a stabiliz-
ing influence, but I feel that the time has
come, as the end of the global war in which
we are involved approaches, for these men
who have so long given their time,
ability, and advice, to adopt and train an
understudy, if you please. I believe that the
younger men under forty who will return from
the war soon, we hope, must be encouraged
by indoctrination, training and advice from
those who have been interested leaders so
long to become interested and active in or-
ganized medicine. This might well become an
objective of the Past-Presidents Club.
Exchange of good ideas is necessary for
progress. Therefore, the medical societies of
the state and progressive doctors are request-
ed to forward to the editor of the Association
352
News and Comment
June, 1945
medical essays and articles of interest. Re-
view of the literature will become more in-
teresting and complete than in the past. Your
cooperation is needed and requested. Your
suggestions are welcome.
L.W.L.
News and Comment
Dr. Edgar G. Ballenger, Atlanta, president of
the Southern Medical Association, died Friday
morning, June 1, and the funeral was held
Saturday afternoon. His death was caused
from a fall in his hotel.
Dr. Ballenger was born November 20, 1877,
in the Blue Ridge Mountains near Tryon,
North Carolina. He was graduated with the
M.D. degree from the University of Maryland
in 1901 and began practicing in Atlanta in
1904. He was one of the outstanding urolo-
gists of the nation. A most cordial and mag-
netic personality, he was a past-president of
the American Urological Association and or-
ganized and served as the first president of
the Southeastern Surgical Congress. He leaves
a son, Cpl. Edgar Ballenger, Jr., at Keesler
Field, a sister, Mrs. J. B. Mosely, Atlanta,
daughter, Mrs. C. M. Foster, Atlanta, and a
brother, Claude W. Ballenger of Tryon, North
Carolina.
A great spirit of the Southern Medical As-
sociation is no more and the great city of
Atlanta has lost one of her best loved phy-
sicians.
Dr. E. Vernon Mastin, St. Louis, Missouri,
who was elected vice-president of the Southern
Medical Association at its last annual meet-
ing, succeeded to the presidency of this great
medical association on the death of Dr. Ballen-
ger. He is worthy in every respect and will
grace the position well.
Dr. William Bradley of Conway, Ark., died
on June 1 at the age of 71. He was a native
of Alabama and practiced at Blocton for forty
years. He was an able practitioner and a good
citizen.
It is with deep regret that we learn of the
passing of Dr. E. C. Boyd of Amory. He was
one of the anointed in general practice in the
country, one of the best informed men in
medicine in the state. He lived a great life be-
cause he served well with his heart and soul
in the practice of medicine. He was indeed a
war casualty in civil practice. Also, Dr. W.
F. Coleman was another faithful practitioner
and a fine citizen who paid the price.
JUNIOR COTTON QUEEN
Miss Martha Robins, daughter of Dr. and
Mrs. R. B. Robins, is the new Junior Cotton
Queen of Camden, Ark. Dr. Gus Street and
Dr. W. H. Anderson recall the warm hospitality
extended by the Robinses when these two
Mississippi men were on program in this
fine town.
REFRESHER COURSE
The University of Illinois College of Medicine
announces its sixth semi-annual refresher
course in laryngology, rhinology and otology,
September 24 through September 29, 1945,
at the College, in Chicago. The course is in-
tensive and largely didactic, but some clinical
instruction is also provided.
Write to Dr. A. R. Hollender, Chairman, Re-
fresher Course Committee, Department of Oto-
laryngology, University of Illinois College of
Medicine, 1853 West Polk Street, Chicago 12,
Illinois.
SIX-DAY PROGRAM
The Department of Legal Medicine of the
medical schools of Harvard, Tufts, and Boston
University in association with the Massachu-
setts Medico-Legal Society will present a six-
day program, October 1-6, 1945, of lectures,
conferences, and demonstrations having to do
with the investigation of deaths in the interest
of public safety.
EYE BANK
The formation of the Eye Bank for Sight
Restoration, New York City, which collects
and preserves healthy corneal tissue from
human eyes for transplanting to blind per-
sons, is a forward step in medical and surgical
education. The purpose of this organization is
to make available to hospitals and surgeons
healthy corneal tissue, removed by consent of
the next of kin a few hours after death. This
operation to restore sight to the blind is ef-
fective in only one type of blindness — that
caused solely by opacity of the cornea when
the rest of the eye and optic nerve are normal.
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
DERMATOLOGY
Archives of Dermatology and Syphilology,
Vol. 51; No. 3, March 1945, p. 210.
Cancer of the Eyelid. Lester Hollander and
Francis J. Krugh, Am. J. Ophth. 27:244,
March 1944.
In a group of 2,601 patients suffering from
cancer of the skin in one form or another
treated at the Pittsburgh Skin and Cancer
Foundation, 239 had cancer of the eyelid. The
authors, however, report only on 125 of the
239 cases. They first discuss the anatomic and
the morphologic aspects of cancer of the eyelid
and its differential diagnosis and classify it
according to microscopic appearance in one of
four groups: 1) the basal cell, or hair matrix
type: 2) the squamous cell, or epidermoid,
type; 3) the mixed cell type and 4) the mela-
noma type. Of the 125 patients under dis-
cussion, 79 were men and 46 were women.
Their ages ranged from 25 to 80 years. It is
the opinion of the authors that cancer of the
eyelids should be excised whenever possible.
In carrying out surgical repair the following
considerations must be kept in mind: 1) that
careful repair of the palpebral conjunctiva
when it has been damaged is imperative; 2)
that proper support of the eyelids depends
on properly reconstructed tarsal plates; 3)
that distortions of the margin of the eyelid
which cause inversion of the cilia are to be
avoided, and 4) that undue scaring is followed
by retractions and formations of an ectropion,
which also have to be avoided. Thirty-five of
the 125 tumors were treated surgically, with
thirty good and five bad results. Radio knife
excision followed by repair with pedicle graft-
353
ing was carried out in twelve instances, with
nine good and three bad results. In another
group of cases, in which the growth occurred
at the inner cantheus and was firmly fixed to
the fibrous structures of the surrounding area,
electrodessication was used. This was done
in thirteen cases, with seven good and six
bad results.
There were a number of reasons which
prompted the use of methods other than sur-
gical. These included the following: 1. The
cancer was considered inoperable on account
of its extension and size. 2. The patient was
considered a poor operative risk. 3. The patient
refused operation. In these instances roentgen
irradiation was used. An eye shield made of
soft lead alloy is used to protect the eyeball.
It was sterilized by allowing it to remain in 70
per cent alcohol for ten minutes and then
placing it in sterile water for five minutes to
remove all traces of alcohol. Sterilized liquid
petroleum was then dropped on the concave sur-
face to act as a lubricant. The energy was ob-
tained from a iShaoul type of tube which has
a focal roentgen ray skin distance of three
to five cm., depending on the length of the
applicator used. Daily treatment of 500 r each
were given, and these varied from ten to twen-
ty, depending on the severity of the reaction
produced. If the contact Chaoul tube for irra-
diation is not available, low roentgen rays may
be used. Hollander and Krugh gave 350 r of
low voltage radiation to carefully shielded
areas in daily treatments, usually ten consecu-
tive daily treatments being required. Thirty-
eight patients were treated with roentgen rays,
seventeen with the Chaoul contact modality.
Good results were obtained in twelve and bad
results in five cases. Twenty-one tumors were
treated with the ordinary low voltage eradia-
tion, with fourteen good and seven bad results.
There were instances in which several methods
of treatment-excision, electrodessication, roent-
gen rays and radium had to be used. All twen-
ty-three patients were so treated, with seven-
teen good and six poor results.
PEDIATRICS
Local Penicillin Therapy in Ophthalmia
Neonatorum' — Sorsby, Arnold and Hoffa,
Elizabeth: British Medical Journal, 1:114,
January, 1945.
354
Interpreting Medical Literature
June, 1945
“Unlike the sulfonamides, penicillin re-
mains effective in the. presence of pus. It
therefore has possibilities for the local thera-
py of ophthalmia neonatorum as an alterna-
tive to general sulfonamide treatment of this
affection. To investigate this possibility 47
infants at the Ophthalmia Neonatorum Unit
at White Oak (L.C.C.) Hospital were treated
with penicillin.”
1. “Initially, penicillin was used in a con-
centration of 500 Oxford units per cc. Eight
cases received this treatment, one drop of
the solution being instilled hourly during the
first twenty-four hours, and continued two-
hourly subsequently. Only three of these eight
cases were cured. Two more showed an initial
recovery, which, however, was not maintained.
The three cured cases required treatment for
two, three, and six days, respectively.”
2. “A second series of seven cases were
treated with penicillin, this time in a concentra-
tion of 1,000 units per cc., the method of
application in three cases being as in the first
series, and in the remaining four cases the
penicillin was instilled at half-hourly intervals
for twenty-four hours and hourly subsequent-
ly. Four of this series of seven cases clinical
clinical cure in two, four, two and five days,
respectively; one case did not respond to treat-
ment, while the remaining two cases both re-
lapsed after an initial recovery.”
3. “A further ten cases constituted a third
series treated with penicillin, this time in a
concentration of 1,500 units per cc., (the
drops being instilled half-hourly during the
first twenty-four hours and hourly subsequent-
ly). Six of these ten cases showed an excellent
response, clinical cure being obtained in eight-
een hours in one case, in two days in four
cases, and in three days in the remaining case
successfully treated. Two cases showed a poor
response in spite of treatment for four and
one-half and five days, respectively; in one
case penicillin treatment was discontinued
after three days as progress appeared inade-
quate; in the remaining case of this series an
initially satisfactory response which gave a
clinical cure within two days was followed by
a relapse which did not respond to further
penicillin therapy.”
4. “Twenty-two infants were treated with
penicillin in a concentration of 2,500 units per
cc., the drops being instilled half-hourly for
the first three hours, then hourly for twenty-
four hours and two-hourly subsequently. In all
but one case there was an excellent clinical
response, recovery in some instances being a
matter of a few hours.” Clinical cure occurred
in six cases in from three to twenty-four hours,
in seven cases in from twenty-seven to forty-
three hours and in seven cases in from fifty
to one hundred hours. One case was omitted,
as the complication of corneal ulcer — present
on admission — delayed a return to normal.
“One point deserves stressing. Rapidity of
clinical cure does not seem to depend al-
together on initial mildness of the condition.
Of these twenty cases, four were severe; they
cleared up in thirty-six, forty, forty, and thirty-
seven hours, respectively, while all the seven
cases that required fifty to one hundred
hours were either mild or moderate.”
“Of the twenty-five cases in the first three
series, only thirteen showed clinical cure,
five more relapsed after apparent clinical cure,
and seven gave a poor response or none at
all.”
“No fine conclusions can be drawn from
these results. So far as this series goes it
would appear that none of the organisms met
in ophthalmia neonatorum are completely re-
sistant to penicillin. A rather surprising feature
emerges with the three oases of inclusion blen-
norrhea present; theoretically no result would
be expected, but in two cases there was an
initial recovery, only to be followed by a
relapse.
“The twenty-two cases treated with penicil-
lin in a concentration of 2,500 units per cc.
bear out the efficacy of the drug for the vari-
ety of causal organisms of ophthalmia. Treat-
ment was successful in the five cases due to
the gonococcus, the nine caused by staphy-
locci, the three in which staphylococci and
bacilli were present, and in the two in which
inclusion bodies were found; two further cases
in which no organisms or inclusion bodies were
present also responded to penicillin treat-
ment. No relapses were observed in this series,
and the only failure was a case in which no
organisms were found in the smear and the
culture showed diphtheroids.
“It would therefore appear that penicillin
is effective over the whole range of causal
organisms with the possible exception of diph-
theroids— though even here two cases respond-
ed to penicillin in a concentration of 1,000 and
1,500 units, respectively, and a third case
showed a partial response to penicillin (1,500
units per cc.) . . . Three of the seven cases
June, 1945
State Board of Health
355
treated with penicillin in a concentration of
2,500 units and requiring treatment for more
than fifty hours showed diphtheroids — one
of them in association with staphylococcus al-
bus. In no case in which diphtheroids were
found was there a rapid clinical cure.”
“Five cases among the first twenty-five were
treated with penicillin after a poor or pro-
tracted response to sulfonamides. Three of
these were cases of gonococcal ophthalmia and
responded well to penicillin, used in concentra-
tions of 500, 1,000 and 1,500 units, respective-
ly. In the fourth case Staphylococcus aureus,
and in a fifth diphtheroids, were present; in
both these cases there was a satisfactory re-
sponse to penicillin in a concentration of 1,500
units per cc. Initially the first case had been
treated by sulfathiazole for twelve days, and
the four others by sulfamezathine for five
and one-half, twelve, five and one-half, and
twenty-three days, respectively. Clinical cure
by penicillin took place in three, four, .two, and
three days, respectively, in the first four cases
STATE FEVER THERAPY UNIT FOR
NEUROSYPHILIS
by
A. L. GRAY, M.D., Director
Division of Preventable Disease Control
The State Fever Therapy Unit, a project
of the Mississippi State Hospital in collabora-
tion with the Mississippi State Board of
Health, has been organized for the purpose
of treating early neurosyphilis, thereby pre-
venting the serious manifestations from oc-
curring which may eventually require com-
mitment to an institution for the insane. The
unit is located at the Brookhaven Public Health
Treatment Center, Brookhaven, Mississippi, and
is so arranged that there will be four six-bed
wards to accomodate both colored and white
patients, male and female. In direct connec-
tion with the patient wards are six fever
therapy rooms, fully equipped with the latest
type of cabinets. The personnel will consist
of the medical director and a complete staff
of specially trained nurse technicians and
staff nurses.
The county health officers are charged by
law with the responsibility of referring pa-
and in eighteen hours in the fifth case.
“Method of treatment — On admission the
infant’s eyes are irrigated with half-normal
saline at room temperature and one drop of
penicillin is instilled. Irrigation is also carried
out before each further instillation of penicil-
lin so long as there is any discharge. With
penicillin in a concentration of 2,500 units per
cc. irrigation is generally not necessary
after six hours. Penicillin is continued for
forty-eight hours after apparent clinical cure,
at two-hourly intervals during the day and
three-hourly at night. The drug is well tole-
rated by the infant’s eye. Occasionally a mild
transitory flushing of the conjunctiva is ob-
served.”
COMMENT
This investigation and method of treatment
with penicillin of ophthalmia neonatorum is
quite interesting. It reveals a remedy which
is new and now available and also one which
may be used without fear of injurious effects
to the eye.
tients from both public clinics and private
physicians. Every effort will be made by the
staff of the State Fever Therapy Unit to co-
operate fully with county health officers and
private physicians by rendering consultation
service and by administering fever-chemo-
therapy to those patients who fulfill the re-
quirements for admission. It is recognized
that patients with asymptomatic neurosyphilis
with type III spinal fluid are prone to develop
the more serious manifestations of neuro-
syphilis, particularly paresis. Therefore, at the
beginning, it is planned to select this group
of patients for treatment, fulfilling the stipu-
lated purpose of the State Fever Therapy Unit
as set up by law. The present limited facilities
will not make it possible to extend such
therapy beyond this group, even though there
are other types which might doubtless benefit
from fever-chemotherapy. The ultimate aim of
the program is to bring under control the
neurosyphilis problem in Mississippi, which
can be achieved only through the combined
efforts and cooperation of ‘health officers,
practicing physicians, and others responsible
for the conduct of this program.
State Board of Health
Felix J- Underwood, M .D.
356
State Board of Health
-June, 1945
Dr. H. Worley Kendell of the United States
Public Health Service has been appointed medi-
cal director of the Chicago Intensive Treatment
Center. Dr. Kendell is well qualified for the
task confronting him and his staff and is in
fact one of the country’s outstanding authori-
ties on fever therapy. A graduate of the Uni-
versity of Cincinnati medical school, he served
his internship at Miami Valley Hospital, Day-
ton, Ohio, where he was also resident physi-
cian in pathology and did research work in
fever therapy. Later he was associate director
of the Kettering Institute for Medical Re-
search. Dr. Kendell also served as director of
the department of physical medicine at the
Miami Valley Hospital. He has contributed
numerous articles to medical journals both in
this country and abroad.
The establishment of a State Fever Therapy
Unit for Mississippi is a real advance in the
control of neurosyphilis and should reduce con-
siderably the number of cases which usually
develop mental and paralytic symptoms and
thus become permanent public charges at great
expense to the state.
*****
Mississippi’s Enrichment Program
The Enrichment Acts, passed by the 1944
session of the Mississippi Legislature, became
effective on February 1, 1945. This legisla-
tion requires that all white flour and bread
and all degerminated corn meal and grits
sold in the state must be enriched. It does
not apply to whole wheat flour or home
ground meal. A similar act requires that all
oleomargarine must be fortified with Vitamin
A.
The Mississippi State Board of Health, which
is designated as the enforcement agency for
the enrichment program, has allowed an ad-
ditional six months after February 1 for the
corn millers to secure necessary equipment
and for the merchants to clear their stocks of
the non-enriched products. The mills and the
wholesale and retail merchants have given
their whole-hearted cooperation in this pro-
gram. As a result, the major part of the
flour, bread, degerminated meal and grits
being sold in Mississippi is already enriched;
all of the oleomargarine has added Vitamin
A. Complete compliance is expected well be-
fore the final strict enforcement date of Sep-
tember 1, 1945.,
“Enrichment,” points out Miss Mary Stan-
sel, nutritionist, “means that that part of the
vitamins and minerals lost in the milling pro-
cesses have been put back into the wheat and
corn. Enriched products taste just the same,
look just the same and cook just the same
as the non-enriched. The only difference — and
it is a big one — is that the enriched products
supply more of the nutrients needed for good
health. The enrichment program will no doubt
mean a substantial decrease in the incidence
of pellagra and certain deficiency diseases.
The enrichment of white flour and bread with
thiamine, riboflavin, niacin and iron, and the
enrichment of degerminated corn meal and
grits with thiamine, niacin, and iron is a
sound, practical and inexpensive way to
achieve better nutrition and thus better health
for the people of Mississippi.”
“Bread enrichment should be continued,”
states an editorial in the Journal of the Ameri-
can Medical Association (January 20, 1945),
in commenting upon this wartime measure
which brought compulsory enrichment on a
nation-wide scale. Following “the emergency
the problem reverts to the individual states,
many of which have already passed legisla-
tion to insure continuance of these benefits
to the nutritional standard of the people. “The
enrichment of flour and bread is considered
particularly desirable,” points out the editorial,
“because these foods are consumed daily in
significant amounts by practically every one
. . . “The effect of the widespread increase in
consumption of these enriching substances on
the nation’s nutrition as a result of mandatory
enrichment of all white bread and rolls is
difficult to measure accurately at this time.
All methods of appraisal, however, indicate a
definitely beneficial influence . . .
“The benefits which accrue to the vastly
greater number of individuals suffering from
milder chronic degrees of deficiency states,
in many cases unrecognized or attributed to
other causes, can probably be considered the
greatest contribution of enrichment. An im-
provement in the general health and well
being and an increased efficiency in the popu-
lation as a whole may be anticipated, since
carefully controlled experimental groups have
shown measurable benefits as a result of
dietary increases of enrichment materials to
enrichment levels.”
The enrichment program has the endorse-
ment of the Food and Nutrition Board of the
National Research Council and the Council
on Foods and nutrition of the American Medi-
cal Association, the American Public Health
Association, and others, who appreciate the
June, 1945
State Board of Health
357
important contribution it has made to health
and efficiency.
*****
Mississippi Needs More Hospital Maternity
Beds
In recent weeks the Division of Maternal
and Child Health of the Mississippi State
Board of Health has attempted to determine
the total number of maternity beds available
in Mississippi and the total needed. Dr. Vir-
ginia Howard, director of the Maternal and
Child Health Division, has estimated the state’s
needs of hospital maternity beds at 1,600;
whereas there exists at the present time only
about 600. These are distributed as follows:
White
Colored
Delta section
95
38
Bluff section
60
16
Coastal section
43
14
Northeast section
202
31
South central section
125
31
The increased number
of hospital deliveries
during the past two years seems a trend which
will continue and is one which will have a
profoundly beneficial effect on maternal health
in Mississippi. As a result many hospitals in
Mississippi have become interested in adding
to their maternity facilities, making them more
adequate to serve current needs.
Attention is again called to the fact that
in 1943 the state had the lowest white mat-
ternal death rate in its history — 2.3 per 1000.
However, the Negro maternal death rate for
1843 was 5.3, the same as that for white
eight years ago. It is believed that good hos-
pital maternity facilities together with good
obstetric care will make it possible with a few
years to reduce these rates substantially. In
the past five years Mississippi has lost 1400
women through deaths due to childbirth.
Twenty maternity beds for every 25,000 popu-
lation in the stats would go a long way toward
insuring proper hospitalization and care for
every mother at time of delivery.
Mississippi Emergency Maternal and Infant
Care Program Completes Second
Year
Through the assistance of 786 physicians
and 117 Mississippi hospitals, the Mississippi
Emergency Maternal and Infant Care Program
has given help to more than 16,000 wives and
infants of enlisted men now serving in the
armed forces. According to Dr. Virginia How-
ard, director of the Mississippi program, every
maternity case has received medical services
at the time of delivery, with more than two-
thirds of all cases being hospitalized at time
of delivery.
The program has not only boosted morale
among the men in the armed forces in know-
ing that good care was provided their wives
and infants; it has also proved a stimulus to
hospitals providing maternity services to en-
large and improve their activities. Many of
the young mothers have, under this program,
had their first babies, and they will have been
taught to seek the same safeguards in any
subsequent pregnancies which they were of-
forded under EMIC. For the contribution which
has been made to improved maternal and
child health, appreciation is due the physician,
the hospital, the nurse and the public health
worker who assisted in the program.
*****
One-Day Postgraduate Course in Pediatrics
and Obstetrics
Physicians were most enthusiastic in re-
gard to the five one-day postgraduate courses
which were recently held in Mississippi through
the cooperation of Tulane University School
of Medicine. From all the comments which
came in following these one-day courses, the
physicians of the state consider them quite
worth while and have expressed a desire for
more. Consequently, an effort is being made
to repeat these courses, holding them in five
other parts of the state in the early fall. The
earlier courses were held in Jackson, Hatties-
burg, Tupelo, Greenwood, and Meridian, with
Drs. Ralph Platou and George Mayer as lec-
turers.
PREVALENCE OF COMMUNICABLE
DISEASES IN MISSISSIPPI
Acute poliomyelitis
t^pr.
1945
2
Apr
1944
2
Apr-5
yr. avg.
2.4
Bacillary dysentery
544
482
440.8
Dengrue
0
0
.8
Diphtheria
29
11
26.0
Influenza
3223
3834
3450 8
Measles
2200
3865
3556.6
Meningococcus meningitis
20
22
29.8
Other forms meningitis
0
12
5.4
Pellagra
204
261
286.2
Pneumonia
1220
1510
1356.6
Pulmonary tuberculosis
107
117
135 8
Scarlet fever
49
16
42.6
Smallpox
0
0
2.2
Tularemia
7
15
96.0
Typhoid fever
5
5
7.0
Typhus fever
10
6
4.6
Undulant fever
7
5
3.8
Whooping cough
896
1458
1233.0
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Doctors, Democrats and Demagogues
J. A. RAYBURN, M.D.
Pontotoc, Miss.
have selected as my subject “Doctors,
I Democrats and Demagogues,” because of the
tremendous impact of each group, separate-
ly and collectively, upon our social, economic,
and political structure, and because they are
a part of the fabric of scientific medicine.
Doctors
From time immemorial doctors have played
an important part in the lives of people. Primi-
tive people, with their unorganized society,
have depended much on their medicine men.
They not only imbibed their concoctions when
they were sick, but sought their advice on
all matters pertaining to their own welfare
even when they were well. Doctors have been
in the vanguard of all organized and progress-
ive governments, and sometimes have even
carried the torch of enlightenment. They have
kept pace with whatever progress humanity
has made. Ethical practices and conduct have
been observed with a reasonable degree of
fidelity, in keeping with the society they rep-
resent and serve. They seem to be an in-
dispensable part of society on any level, in
war or in peace.
Within the medical profession it has been
our great good fortune to know men of the
highest ideals and culture, and in general,
to find in the profession a great friendliness.
Our common interests bind us together, and
although we frequently disagree, there is to-
day, as there has been throughout the cen-
turies, in Osier’s words, a “remarkable soli-
darity.”
Great and indispensable as the medical art
is, it is something more than skill that con-
stitutes the genius of the true physician. It
is love of humanity, a desire to do the ut-
most, at any cost, to alleviate human suffer-
ing and restore the afflicted to wholeness of
being.
A doctor is not a superman or magician.
He is a human being, with human sympathy
♦This paper was originally prepared to be read
before the Section on Surgery at the Mississippi
Medical Association in May, but due to wartime
transportation difficulties the scientific sessions were
pretermitted.
and understanding, working within the limits
of scientific knowledge. But he achieves vic-
tories today which, only a few generations
ago, would have been called miraculous.
With the help of modern scientific equip-
ment, with a fund of coordinated medical
and surgical knowledge undreamed of even
by our grandfathers, doctors can prevent dis-
eases that were once supposed to be the natural
heritage of mankind. They can cure diseases
which were once unqualifiedly labeled “fatal.”
The service that medical science renders is
often obscure and unnoticed. It receives little
of the world’s applause and oftentimes too
little compensation. The unwritten story of
what transpires in the hospitals and frequent-
ly in the homes of humble and neglected folk
is one that has never been adequately told.
There is no form of philanthropy of which
we have knowledge comparable to that which
is repeatedly exhibited by the healing profes-
sion. Doctors and nurses render a service of
such high order that we find it impossible
rightly to appraise it.
Charity is an eminent virtue of the medical
profession. Show me the garret or the cellar
which its messengers do not penetrate; tell
me the pestilence which its heroes have not
braved in their errands of mercy; name the
practitioner who is not ready to be the ser-
vant of servants in the cause of humanity,
and whose footsteps are found to every haunt
of stricken humanity.
Rightly conceived and practiced, it is a
ministry that deals with the whole man, body,
mind and spirit. We have known physicians
whose presence in the sick room meant as
much if not more than all that they pre-
scribed. In their approach to the sick they
imparted both confidence and renewal. They
penetrated the mind of the patient and dis-
pelled both fear and anxiety. Their word
of encouragement meant more than their
medicine. They were restorers of the soul.
The physician’s ambition has ever been
to relieve and prevent suffering and illness
and the unhappiness that goes with such con-
ditions. By precept and example it has taught
the neophyte that it is his obligation to sacri-
359
360
July, 1945
Doctors, Democrats and Demagogues — Rayburn
fice his comfort, yea even his health, if in
so doing, he could alleviate the suffering of
others. No group, and I do not except the
clergy, has held higher the standards of moral-
ity. No group has striven more earnestly for
the advancement of science.
The letters “M.D.” are a symbol of civiliza-
tion’s achievements in the protection of hu-
manity.
What is it that has enabled the men of
medicine to accomplish so much in blessing
humankind by the alleviation of physical woes ?
The question may well be answered in the
language of an ancient sage, who once wrote
these immortal words: “Interest does not bind
men together: interest separates men. There
is but one thing that can effectively bind
people, and that is a common devotion.’’ There
are a number of loyalties in life — those to a
nation, to a college, to the community in which
we dwell, to our family, and to our friends —
“All of which are somewhat akin; yet there
may be something of personal interest, pre-
judice, or defense in these particular reactions
which makes them not wholly unselfish.” De-
votion, on the other hand, may be likened un-
to that charity so beautifully delineated by
the Man of Tarsus — for devotion suffereth
long , and is kind; devotion envieth not.
Devotion is the doctor’s consecration to his
task. It is a sort of blood kinship with these
who have been led into the Temple of Pain.
This is the true spirit of medicine. It is
this that casts out the devils of disease. De-
votion, wedded to true science, has won for
many a tortured soul freedom from agonies un-
speakable, and restoration to the hearth of
health.
My fellow physicians, we are servants of
humanity and have a humanitarian service to
perform which can be accomplished by or-
ganization, cooperation, education, devotion
and freedom.
Democrats
Democrats have been the free thinkers of
the world, and whether they live in a society
of free thinking people, an autocratic or to-
talitarian state, most of the philosophy which
has guided humanity towards a higher plane
of living has been furnished by true democrats.
It is now 168 years since the brilliant pen
of Thomas Jefferson gave us three brave
dreams. They were dreams that shook the
complacency of a world of kings and foreign
rulers, that were to light up the tired and
broken hearts of men everywhere — “that all
men are created equal, that they are endowed
by their Creator with certain unalienable
rights, that among these are life, liberty and
the pursuit of happiness.” I wonder if in all
written language there is a phrase that match-
es those last seven words. They cover man’s
fondest hopes since the mist slowly lifted
a million years ago and human beings began
to ponder on the meaning of existence.
They express simple dreams. They want
Only that man shall have his own life to do
with as he chooses; they ask that man shall
have personal liberty; and that he shall have
the right to pursue such happiness as he
wishes. They were put down on imperishable
parchment and signed by fifty-six valiant men
at a moment when it was not easy for com-
mon man to have for himself or his family
any of these three things. Life was cheap and
could be all but bought and sold by the whims
of distant rulers. Men were free neither to
think nor to talk nor to act as they chose.
And they could follow their stars of happiness
at great risk and great cost.
These fifty-six sorely-tried men, and their
countrymen who dreamed with them, pledged
their all in order to build a new world based
on an untried and imaginative theory called
democracy.
It was vague then, and it is vague now after
all these years. And it will always be vague
because it is built in men’s hearts and ce-
mented by men’s dreams. But this gives it a
purpose and strength beyond measurement.
To us our democracy means the American
way of life. After analyzing the American way,
I find it embodies this principle: It is the
free way of life. The individual is allowed to
live in accordance with the dictates of his
own conscience. He is free to aspire, to pro-
test, to criticize, and to follow any vision in
his heart or mind which leaves his neighbor
equally free. In America a person may talk
his way to the truth of things, realizing that
although the governmental organization is the
agency for the general welfare, it leaves full
leeway for the talented person to attain the
highest development of his talents commen-
surate with neighborly, social conduct. He is
assured this free spirit by the Bill of Rights.
The American way permits living by the rule
of reason. It enables men to put into appli-
July, 1945
Doctors, Democrats and Demagogues— Rayburn
361
cation mankind’s most important heritage
intelligence. This aspect promotes fair govern-
ment as contrasted with the oppression and
suppression characteristic of autocratic gov-
ernments.
It is the friendly way of life. It takes into
consideration the rights and opinions of mi-
norities, the underprivileged, and the least
favored. It places restrictions upon the sel-
fishness of the mass and class, so that they
do not trample on the privileges of others.
An individual at the very bottom of the scale
can climb to the top — for success is judged in
terms of growth and happiness.
It is the peaceful and cooperative way of
life. It emphasizes service for the common
good. Discrepancies are settled through en-
lightened discussions, elections, or through
court procedures. The use of armed force is
a means of last resort.
The American way is the fair way of life.
The democratic principle requires each per-
son to recognize the equal rights of others.
Here, individuals in determining the condition
of their own lives, whether political, economic,
religious, or social, are guided by the thought
that their rights are everywhere limited by
the equally valid rights of their neighbors;
that their neighbors are always to be treated
as human beings, as ends in themselves, never
as mere instruments.
Finally, it 's the democratic way of life
based on human brotherhood and the Golden
Rule. In America attemps are made to bring
the benefits of civilization to the common
man, to give him a high standard of living,
educational opportunities, and protection for
his health and safety. In a word, the Ameri-
can way epitomizes Christian philosophy.
In verity, I would not change our democracy
with the life it entails for any other system
in the world. But if our democracy is to mean
as much to us tomorrow and a thousand mor-
rows hence, we must fully understand it and
fulfill our obligations. We must be educated in
civic matters. We must obey our leaders, yet
assert the responsibility of advising them. We
must play fairly, yet be mindful of every op-
portunity for free action and the exercise
of initiative, for then only will the success
of democracy be assured and insured forever.
Then only will we continue to breathe every
day a fresh delight in its generous attitude
toward life, and the inspiration it affords its
citizenry.
Demagogues
Demagogues flourish in all types of society,
but they are in their zenith of glory in a
democracy where they are allowed to expostu-
late freely and often. Even though they some-
times become nauseating to certain sections
of society, they are possibly a benevolent
factor in a democracy, because there are those
of us who might become super important
factors, and altogether too cocksure, if it
were not for the flambouyant glamour of the
demagogue.
It was Dr. Osier who said to a group of
students entering Johns Hopkins: “If you
look forward to a lucrative practice, go home.
If you enter medicine in exactly the same
spirit that the missionary leaves for his foreign
field, that is, believing that in medicine you
best can use your talents for your fellow men,
we welcome you.” In this day and age it is
too much to expect doctors to have so pure
a missionary spirit as to be totally indifferent
to money and the comforts and security it
can buy. But it may still be assumed that
a doctor who is worthy of the name will find
his greatest reward in the satisfactions he
derives from pursuing a science and from im-
proving the lot of humanity. The fact that
many doctors have placed these satisfactions
first justifies the conclusion that this is not
an impossible human ideal.
The majority of the members of the medical
profession are no doubt doing all that they can
to raise the standards of medical practice.
The national phantasy of socialized medi-
cine is to my mind a dream of the bleating
heart of the demagogue. Those of us who be-
lieve in a free and strong America must be
on guard. Put agriculture, industry, and the
professions in a strait jacket of regimentation
and bureaucratic control, and the only possible
result would be, we should lose the way of life
which has given the people of this nation more
of the worthwhile things than have been at-
tained by the people of any other land.
What do we do about it? We cannot sit
idly by and watch this system disappear be-
fore our eyes. We cannot permit the inefficient
and the incompetent, the crystal gazers and
the experimenters to ruin this America of op-
portunity for all of us.
In a republic all men and all women must
be granted equal rights. If we do not adhere
to this great fundamental principle of Ameri-
362
Doctors, Democrats and Demagogues — Rayburn
July, 1945
canism, we are not worthy of the proud privi-
lege of being American citizens.
There should be equality in the administra-
tion of the law; there must be justice in the
distribution of the tax burdens. A square deal
to all must be the cornerstone upon which
we build a continuous progressing America.
To those who have had experience with the
muddling of government, the demand for more
of it in medicine in the name of efficiency
has an ironically humorous note. What city
has not had scandals in its health department?
Some state and county health departments
are little better. It is said that one Southern
state has had twenty-two state health officers
in twenty-three yeans. Health department of-
ficials may be appointed for their merits but
are often selected for political “availability.”
It is said that in one large city recently a dy-
ing man was turned away from a city hospital
by a receiving nurse because he was not ac-
companied by a policeman! And the sick man
happened to be an employee of the very hos-
pital where he applied for emergency treat-
ment. A tragic paradox indeed!
How dubious then the prospect of turning
over all care of the sick to government.
Future medical progress would practically
stop under socialized medicine, for, there being
no competition, doctors would not strive to
improve their service. Doctors would no longer
be masters of their talents, but would have
sold or bartered them to an unprofessional
group of politicians. Many of our future great
surgeons would be deviated from the hard
road of a medical education to more promising
lines. For the future of progressive medicine
and for the welfare of the American people as
a whole, may the doctors continue as in the
past.
Let us all become true sentinels in the watch-
towers of a free and untrammeled America.
Let us see to it that the flag of personal ini-
tiative shall not be dragged down from the
mast of private enterprise by the dirty hands
of the disciples of Karl Marx, and in its stead
run up the red flag of socialized medicine and
state socialism.
We hope that we can persuade the general
public to support us in our resistance to
Senator Wagner’s new law which would place
us completely under the control of the federal
government. We say free evolutionary medi-
cine not revolutionary bureaucratic medicine.
We need men and women, lots of them, who
will stand up on their two feet before the
world and say, “We do not intend to preside
at the liquidation of the American way of
life. We are going to maintain our American
standards of living under representative, demo-
cratic principles, free from government domi-
nation.”
You may well ask, Why am I mixing these
three segments of society in a paper to be
read before a group of professional men? My
answer is, that the three segments are a mix-
ture of society, that the noble profession of
medicine is interspersed with the medical dema-
gogue, who considers medicine as a means to
his own ignoble purposes. I am glad that there
are so few such members within the pro-
fession.
All doctors have not reached a state of
idealism in their profession. But the majority
of them are constantly striving to improve in
quality and scope. I do not believe that social-
ized medicine is the answer. Give them con-
structive criticism and light, and they will
find the way, because I believe in this country
most of them belong to that class of demo-
crats which has helped to guide humanity to-
ward a higher plane.
Our salvation lies in the joined hand, the
fused spirit, and the consecrated heart — to
reject the false, examine the doubtful and ac-
cept the true. Doctors and democracy will
stand the test.
Where no council is, the people fall: but
in the multitude of counselors there is safety.
— ISolomon (1000 B.C.)
Acromioclavicular Injuries*
JOHN D. DYER, M.D.
Houston, Miss.
Separation of the acromioclavicular joint
occurs often enough for it to be worthy
of our consideration. About two years ago
there was an article on this subject in the
Journal of Surgery, Gynecology and Obstetrics.
It was written by Dr. Boardman M. Bosworth
and described a new technique for repairing
these injuries. At that time he only reported
four_ cases. Since reading Dr. Bosworth’s ar-
ticle, we have repaired four cases of acromio-
clavicular separation by the technique which
he described.
Disability from acromioclavicular separation
is marked when there is coincidental tearing
of the coracoclavicular ligament. This ligament
is very strong and if it were not present, there
would be many more acromioclavicular separa-
tions. There is only slight movement in this
joint, but the fibers of this ligament are so
placed that they reinforce it regardless of
what direction it moves.
In the past there have been numerous major
operative procedures used for repairing these
separations. Fascia, silk and wire have proba-
bly been used more than any other materials.
All required general anesthesia and major
orthopedic surgery which was technically diffi-
cult.
The method described by Bosworth and
which has been used in the cases being report-
ed now consists of passing a single vitallium
screw through the clavicle into the coracoid
under local anesthesia. The operation is done
with the patient sitting upright in a chair. A
small incision is made over the outer third
of the clavicle, parallel with the clavicle, and
about one and one-half inches proximal to its
outer end. The upper cortex of the clavicle is
drilled through with a 3/16 drill. Novacain
is then injected and the lower cortex is drilled
through. Through this hole more novacain is
injected into the torn fibers of the coracoclavic-
ular ligament and into the periosteum of the
coracoid. The dislocation is now reduced and
held in position by an assistant who supports
the arm and depresses the tip of the clavicle.
At this stage of the procedure it is well to
check the position with x-ray. A hole is then
started with a small drill in the upper cortex
of the coracoid process. A vitallium screw is
then placed through the clavicle into the cora-
coid process. This screw will cut its own way
through the coracoid process without pre-
vious drilling.
The hole in the clavicle is made a little
larger than the screw to allow free movement
of the screw within the clavicle which allows
limited motion of the acromioclavicular joint
in all directions. The reduction must be main-
tained until the screw is drilled through the
coracoid and the screw should penetrate both
cortices of the coracoid.
This operation is very simple but should
be done in a hospital. No open bone surgery
should be attempted in an office because of
difficulty in carrying out a sterile technique. It
is probably best to keep these patients in the
hospital overnight, but this is not absolutely
necessary. No sling or support is used, and
the patient is advised to begin active use of
the arm at once. However, lifting and pulling
is not permitted for eight weeks.
The following cases are reported:
Fig-. 1. — J. M., age 75. X-ray before operation.
Case No. 1. J. M., age 75 — Injured in an
automobile wreck. Was seen a few hours after
*Read at the Northeast Mississippi Thirteen
Counties Medical Society, Baldwyn, Miss., December, injury. Was stuporous from a head injury,
363 1944.
364 Acromioclavicular
Pig. la. — Same patient after operation.
but it was noted that the outer end of the
right clavicle projected above the acromian
process of the scapula. Diagnosis of acromio-
clavicular separation was confirmed by x-ray
examination. Since there was an associated
head injury, the acromioclavicular separation
was not repaired until three days after ad-
mission. The repair was carried out in the
manner described. There was moderate pain
in the shoulder for the first two days follow-
ing the repair. After this, there was hardly
any pain. At two weeks there was some drain-
age from the incision, and it was thought that
an osteomyelitis might be developing. How-
ever the draining stopped after one week and
the incision healed completely. At two months
the patient had normal use of the shoulder.
Pig. 2. — J. S., age 34. X-ray before operation.
Case No. 2: J. S., Age 34 — Injured in an
automobile wreck. Was seen about four hours
after injury. Patient was complaining of severe
pain in right shoulder. Examination revealed
an acromioclavicular separation. Repair was
done on the following morning. Recovery was
Injuries — Dyer July, 1945
uneventful. At six months there was normal
use of the shoulder.
Fig. 2a. — Same patient as in Pig. 2 after operation.
Case No. 3: E. W., age 15 — Fell from bi-
cycle on right shoulder three days before en-
entering hospital. Examination revealed right
acromioclavicular separation. Repair was done
about two hours after admission. Recovery
was uneventful. At four months function of
shoulder was normal.
Fig, 3 — E. W., age 15. After reduction with screw.
Case No. 4: G. B., age 17 — Injured left
shoulder while wrestling. On physical examina-
tion there appeared to be a typical acromio-
clavicular separation. However, x-rays showed
a fracture of the outer extremity of the clav-
icle. Since the clavicle was riding high, it was
evident that the coracoclavicular ligament had
been tom and that it could be treated as an
acromioclavicular separation. The only dif-
ference in the procedure was that the fractured
ends of the clavicle had to be manipulated in-
to position before insertion of the vitallium
screw. At six months the function of the
shoulder was normal.
July, 1945
Acromioclavicular Injuries — Dyer
365
Fig-. 4. — G. B., age 17. Before operation.
Fig-. 4a. — After reduction.
THE MISSISSIPPI DOCTOR
David E. Guyton
Blue Mountain, Miss.
The Mississippi Doctor!
Long may it live to lead,
With courage for its watchword,
With candor for its creed.
Despite its small beginning,
It towers high today,
Respected, read and quoted,
With sovereign right to say.
Appearing in its pages,
Are features by the best
Of surgeons and physicians,
Revered by all the rest.
All phases of the practice,
Approved by tests of years
. And every sane adventure
Of sagest pioneers,
These are the sum and substance
This journal joys to bring
And that is just the reason
Its readers rise to sing:
“The Mississippi Doctor!
Long may it live to lead,
With courage for its watchword,
With candor for its creed.
“And may God crown its efforts
With service most sublime
And lengthen out its mission
Until the end of time.”
Rural Health*
VERNON B. HARRISON, M.D.**
University, Miss.
In reporting on the (pfuiblic health status of
a community, it is customary in professional
circles, to consider the subject from the
standpoint of the four P’s ; namely, the popula-
tion, the problem, the program, and the prog-
ress. In the time at my disposal, both for
preparation and presentation, I can do no
more than generalize on these four ^points
as they pertain to the rural health status
of the ten counties represented today in this
Area Rural Life Conference.
THE POPULATION
The total population of the ten counties in;
this Area Rural Life Conference is approxi-
mately one quarter million people, about one-
eighth of that of the state of Mississippi.
This population is composed of about half
and half white and colored people, with a
range of white to colored ratio of from
three to one some counties, to a ratio of
one to three in other counties. The popula-
tion composition is important in any public
health problem because of the significance
of racial factors in disease, as well as its
sociological and economic implications.
The age-group distribution of a population
influences its public health problems. Missis-
sippi is rapidly becoming a state of children
and old people. This is due to the fact that
our young people are migrating from the
state to seek better economic and sociologic
opportunities elsewhere. When the middle-age
group is cut out of a given population it
throws the public health problems of the
younger and older age-groups into greater
prominence. And, with the possible excep-
tion of the venereal diseases, tuberculosis and
conditions associated with childbearing, the
younger and older age-groups contain the
most public health problems ; for example,
the acute communicable diseases, nutritional
deficiency and developmental diseases, and
the degenerative diseases and senescent states.
♦Read before the Area Rural Life Conference,
Oxford, June 8, 1945.
♦♦Professor of Bacteriology and Preventive Medi-
cine, University of Mississippi.
The social and economic status of a popula-
tion also influences the state of its public
health. It is a well recognized fact that where
the sociologic and economic well-being of a
population is high, its public health problems
are minimal. Poverty and near poverty, if
not the mothers, are, at least, the step-
mothers of public health problems. I think
that it is fair to state that the general social
and economic level of the average rural fami-
ly in this area is definitely below the average
for the nation, although not nearly so low
as that of some sections of so-called enlight-
ened Northern cities. Nonetheless, we must
recognize the facts for what they are.
Lastly, there is a direct correlation between
the educational level of the population and its
public health problems. The Scandinavian
countries are a good example of this point.
That is, where the general educational level
is high, the public health level is also high,
and vice versa. Here, again, we must admit
that the general educational standard of our
population is woefully deficient in certain par-
ticulars.
THE PROBLEM
The public health problems of any com-
munity can be classified into three divisions;
namely, disease prevention, health mainte-
nance, and health promotion. Of these three
problems, health maintenance is the oldest
in concept and most immediate in action.
Fundamentally, it means repairing the “hu-
man machine” when it “breaks down” and
getting it back into operation as soon as
possible. Naturally and logically, the responsi-
bility for this service rests with the medical
profession and its allied services; such as, the
dental, nursing, and pharmaceutical professions
and the hospital systems.
What is the health maintenance problem
in this area? Serving a quarter million
people iii this area are 93 physicians who
are not doing full-time public health work or
teaching in the medical school. This is a ratio
of one physician to 2700 people. By comparison
the ratios of , physicians to population in Mis-
sissippi as ; a , whole and in the nation as a
366
July, 1945
Rural Health' — Harrison
367
whole are, respectively, 1 to 1640 and 1 to
800. If one accepts the standard of one phy-
sician per 1000 population as satisfactory, then
this area is short 156 physicians. I have no
readily available data on the dentist and
nursing situation, but I suspect on fairly good
general evidence that in those fields the situa-
tion is far worse.
The hospital aspect of the problem follows,
in a general sense, that of the physicians. The
ten counties contain six hospitals located in
four communities possessing a total of 173
beds and admitting a total of 5628 patients
last year. This is an average of one bed for
every 610 people, or a ratio of 1.43 beds per
1000 population. By comparison, the whole
state has a ratio of 1.5 beds per 1000 popula-
tion and the average for the whole nation
was 3.3 beds per 1000 population. The six
hospitals in question are small, general-ser-
vice hospitals, privately owned, and with a
semi-closed staff. Insofar as I am aware,
there is only one specialist in the area. With
the exception of the state subsidization of the
private hospitals, there is no other provision
in this area for the indigent or near-indigent
sick.
The problem of disease prevention is a de-
rivative or outgrowth of the health mainte-
nance problem. It was only natural that the
inherently high cost of health maintenance
— both in respect to money and life — be re-
lieved by attempting to remove the hazards
which caused or hastened the “break down”
in the “human machine.” The responsibility
for disease prevention should be shared joint-
ly by the organized public health services
and the allied medical profession. It is child-
ish thinking to believe that the responsibility
rests solely with one or the other of these
two systems; in disease prevention these two
services are not competitive but complemen-
tary.
Eight of the ten counties represented here
today have a formal full-time health service.
Yet, in every case two counties share a health
officer. No doubt, this, as well as other staff
problems, is due to the exigencies of the war.
It goes without saying that the unorganized
counties should have the benefit of a full-time
public health service. The major public health
problems appear to be venereal disease con-
trol, tuberculosis control, and maternal and
child hygiene services. However, the formal
organization of a county health department
is, in itself, no assurance that a sound and
efficient public health service will be forth-
coming.
Lastly, health promotion is the newer con-
cept of public health. Even at their best, health
maintenance and disease prevention are nega-
tive and static, whereas health promotion is
positive and dynamic. The objective of health
promotion is to develop the greatest possible
yield from the inherent potentialities of the
human organism. To accomplish this one must
apply methods of development, adaption and
correction, as required. The responsibility for
this service is broad, but fundamentally it
must be divided between the medical pro-
fession, organized public health services and
the educational systems.
THE PROGRAM
The program necessary for solution of the
aforestated rural health problems might be
summarized under four titles ; namely, ex-
panded medical service, organized public
health service, health education, and improved
general economic conditions. It might be truth-
fully stated that improved general economic
conditions could almost single-handedly solve
the whole problem.
The problem of adequate medical service is
fundamentally one of economics. Under pres-
ent conditions it is questionable if this area
could support enough physicians to bring the
ratio to one physician per 1000 population.
Medicine, like any other business, is largely
governed by the law of supply and demand.
However, there are ways and means of im-
proving the situation concomitantly with (not
independently of) the general economic eleva-
tion of the population. In essence, this means
the simultaneous creation and operation of a
system of hospitalization and medical educa-
tion for the state. In my opinion, a medical
school program and a state hospital pro-
gram are not independent alternative solu-
tions to the problem, but rather the medical
school program and the hospital program are
complements of a single solution.
The public health program is so well es-
tablished in the state that it might appear
superfluous to dwell upon the point. However,
it seems to me that two points need clarifi-
cation, The first point is that the “house is
no better than the material out of which it is
built” and a public health program is no
better than the quality of its personnel. In my
368
Rural Health — Harrison
July, 1945
humble opinion a health department should
not be an asylum for professional misfits in
the medical, nursing and engineering pro-
fessions. Any county with a public health
problem, regardless of its economic and politi-
cal prominence or obscurity, is entitled to
competent public health workers. It is the
“backward” and “borderline” counties which
have need of the most efficient and competent
personnel, but all too often they are the ones
which get the “second rate” workers. It is the
second point is like unto the first; namely,
if a county has a competent and efficient pub-
lic health staff, that staff should be given
a high degree of autonomy. During the last
ten years there has been a growing tendency
to centralize public health service in the state.
There can be no argument with such bureau-
cratic methods where the field staff is in-
experienced or incompetent, but with the right
kind of a field staff, decentralized public health
service is the superior service. The people in
these ten counties should demand a public
health program commensurate with their pub-
lic health problems and not accept an inferior
substitute.
As previously stated, education is the natural
enemy of public health problems. However, the
elevation in the general educational standards,
while unquestionably beneficial, is in itself not
sufficient; it must be supplemented by special-
ized health instruction. The term, “health edu-
cation,” is confused in the public’s thinking.
In the past it has been treated as a step-child
by both our educational system and our public
health services. Our schools have given it lip
service and simultaneously violated its spirit,
while our public health service has used it as
a cloak for propaganda purposes. It is hearten-
ing to see a current concerted effort being
made by the State Department of Education
and the State Board of Health to organize
this important field in public health.
Finally, an improved general economy is
necessary for an improved public health, and
vice versa. Pills and inspiring words can never
substitute for food and shelter. Any measure
which will increase the net family income will
elevate its health status. This is, in essence,
the purpose of the Rural Life Council, and it
needs no further amplification at this point.
PROGRESS
It is too early to report any material prog-
ress in the solution of the rural health prob-
lems in this area. The greatest of all progress
has been made by organized public health ser-
vice, but much remains to be done. It appears
that the state has been stirred by the crying
needs in the field of medical service anti 4here
is an undercurrent trend toward a state hos-
pital and medical educational system. There
is a strong sentiment and an increased inter-
est in the problem of health education. The
joint action of the State Department of Edu-
cation and the State Board of Health in this
field is making gradual headway. Finally, the
postwar planning and industrial program fop
Mississippi and the resurgent interest in the
problems of agriculture all point to an im-
proved regional economy.
Let us hope that our leaders will not be-
come so engrossed in a single phase of the
problem that they will lose their perspective
for the overall picture. Let us not be guilty of
not being able to see the forest for the trees.
American Red Cross chapters throughout
the nation will be permitted to recruit blood
donors for civilians under a program announced
by National Chairman Basil O’Connor. The
blood collected and the blood derivatives pro-
duced will be made available without cost to
physicians, hospitals, clinics and patients. This
civilian program is entirely separate from the
Blood Donor Service operated by the American
Red Cross for the armed forces, and the civilian
program will be available to chapters through
the five Red Cross area offices.
Familial Progressive Muscular Dystrophy*
In three generations living in the same
NEIGHBORHOOD
W. A. EVANS, M.D., and C. H. LOVE, M.D.
Aberdeen, Miss.
The Moffett Family
Case One. E. C. M. Twelve-year-old, rosy-
cheeked, bright-eyed boy. Superficially
observed, appears to be well developed
mentally and even physically.
When this boy was about seven years of
age and in his second year at school, it was
noticed that he could not get into the school
bus unless he had the help of the driver. His
mother had some idea of the meaning of this
weakness from her observation of the disease
in some of her brothers, her maternal uncles,
and her maternal cousins. The weakness in-
creased so rapidly that it became necessary
for the boy to stop school. There was no pain
or tenderness or fever or other constitutional
reaction. The disease was most marked in the
muscles of the lower legs. It presently affected
the muscles of the upper legs, the back and
the arms. Although the muscles were so weak
that the boy could not step up, or climb, or
run, or jump, or walk any long distance, they
appeared to be larger than normal. In the
course of time the feet developed a tendency
to toe-in and to turn downward so that the
boy stood pigeon-toed or on his toes. No
other tendency to contractures or spasm was
noted. The boy fell frequently, but it was a
slumping-down that did not expose him to
danger of fractures. He would get up and try
again, not much harmed or discouraged from
the fall.
Due to involvement of the muscles of the
back he had a characteristic exaggerated lum-
bar posture. Appetite good, digestion good,
functions of organs of thorax and abdomen
not interfered with, vision good.
This boy was taken to clinics for examina-
tion twice.
He was examined by Dr. H. B. Boyd in Mem-
phis for the Mississippi Crippled Children’s
Service in August, 1941. Dr. Boyd reported on
August 29, 1941. “This child has a pseudo-
hypertrophic muscular dystrophy. There is no
orthopedic treatment. Has also been seen by
Dr. Hamilton who is placing him on a high
vitamin E diet. Has asked that the child re-
turn in thirty days.”
369
Dr. R. A. Knight examined this boy under
the same auspices at Tupelo, March 25, 1943,
seventeen months later. He wrote Dr. Boozer at
Amory, Mississippi: “Gradual progression of
the syndrome. Gower’s sign positive, some
weakness in shoulder girdle. No treatment ad-
vised. Diagnosis, pseudo-hypertrophic dystro-
phy. To be seen at yearly intervals. There is
gradual progression of the muscular disease
and patient is now unable to arise from the
floor and cannot lift his head from the bed.
Obtained no benefit from vitamin E prepara-
tion. No treatment advised.”
In January, 1945, the boy can hold his
head up and can walk around somewhat both
outdoors and indoors.
Case Two. Howard, now (January 1945) ten
years old. Disease started when this boy was
in his eighth year and in his second year at
school. His difficulty in getting into the school
bus called attention to the developing disease
in this boy.
In this case there is no pseudo-hypertrophic
feature. It is following the more typical course
of progressive muscular dystrophy affecting
about the same groups of muscles that were
affected in the older boy. With that exception,
what was said of the disease in the older
boy applies. This one was not taken to any
clinic and vitamin E pills were not tried on
him. He is a ruddy-cheeked, well-nourished
boy, bright and clear-eyed on superficial ex-
amination.
Case Three. Walter, nine, years of age. In
infancy this boy was noted as having very
large intestines. There was constipation and
much gas. For this condition the baby was
taken to Dr. Williams in Aberdeen and Dr.
Murfree in Amory. The condition was con-
sidered to be congenital. It has improved and
at the present time causes little trouble, but
is responsible for an abnormally large abdomen
and some resultant lumbar lordosis. The boy
is ruddy, well-nourished and apparently in
good health.
He is now two years older than his brothers
were when they developed symptoms of pro-
370
Familial Progressive Muscular Dystrophy — Evans and Love
July, 1945
gressive muscular dystrophy. The parents
think he will escape and they have had ex-
perience enough to qualify them as judges.
The fourth child, a girl, Dorothy Lou, aged
seven years, is a healthy well -nourished child
with no symptoms of progressive muscular
dystrophy.
Case Four. Fifth child, a boy, Jerry, six
years old. The disease is beginning to develop
in this boy’s lower legs, having started after
his fifth birthday. As in the case with the
second boy, the disease is not of the pseudo-
hypertrophic type.
The sixth child, James Edward, four years
old, child is entirely normal. None of the
children developed symptoms at four years
of age. There is no way to tell whether or not
this boy will escape.
The seventh child, Carroll, thirty-two months
old, as in the case with the sixth child, is
bright-eyed and healthy in appearance and
nothing indicates whether he will or will not
escape progressive muscular dystrophy.
The Meek Family
These are the children of Mr. Meek and his
two wives who were sisters, named Carter.
The first child was a son who died at seven-
teen years of age from progressive muscular
dystrophy. The symptoms of this disease were
recognized when the child was seventeen years
of age. His disease was of the pseudo-hyper-
trophic type.
The second child, a daughter, remained in
good health and became Mrs. Moffett, the
mother of three affected and four unaffected
children. After the death of the mother of
these children, Mr. Meek married her older
sister and she bore him four children.
The third, fourth and fifth children escaped.
The sixth child, a son who developed the
disease at seven years of age, died at six-
teen years of age.
The Tubb Family
The first, fourth, fifth, and seventh children
escaped.
The second child, a son named Bennis, de-
veloped progressive muscular dystrophy of
the pseudo-hypertrophic type when he was
nine years of age. He died from pneumonia at
sixteen years of age.
The third child, Winfred, developed recog-
nized symptoms of the disease of the pseudo -
hypertrophic type, at seven years of age. He
died when twelve years old.
The Carter Family
Of eleven children, the first ten escaped the
disease. The eleventh child, a boy, Robert,
developed recognized symptoms of progressive
muscular dystrophy when seven years of age
and died at twenty-five years of age of the
disease.
The Pickle Family
The first four children escaped. The first,
a son, was born a deaf mute. He is now living
and is about forty-five years old and in good
health. He is married and has five children,
three boys and two girls, all in good health
and all normal as to speech and hearing.
The second child, a daughter, had two
healthy children, a boy and a girl. She died
six months ago, never developing any symp-
toms of progressive muscular dystrophy.
The third child, a daughter, May, was born
a deaf mute, but otherwise is normal and
healthy. She is married and has two children,
a boy and girl, both healthy and normal as to
speech and hearing.
The fifth child was a girl, Mamie. When
Mamie was between five and seven years of
age, the family noticed that on the way to and
from school her schoolmates had to carry
her books. The road to school crossed a hill
and after a few months it became necessary for
her to quit school because of her muscular
weakness. Within two years she was confined
to her room, her chair and her bed. Her
progressive muscular dystrophy was of the
atrophic type. The wasting of the muscles of
her legs and trunk became extreme as the
years went on. Her posture became of the
lordosis-square-shoulder type because of her
need to use auxiliary trunk chest, shoulder and
neck muscles. She had no contractures, no
muscle spasms, tonic or clonic, no pains, no
tenderness, no sensory phenomena and no con-
stitutional reactions.
Her death certificate gave as the cause of
death, “Immediate, acute endocarditis; con-
tributing, paralysis,” age thirty-five years.
Date: July 9, 1944.
We note that she suffered from the disorder
for twenty-eight to thirty years. Her father
is still living and is in good health at seventy-
eight years of age. He has never had any
symptoms of progressive muscular dystrophy.
July, 1945
Familial Progressive Muscular Dystrophy — Evans and Love
371
So far as is known, none of his progenitors
and none of his collateral relatives has ever
had the disease. Mrs. Pickle was a Ray. After
a life of reasonably good health, she died
about five years ago when sixty-six years of
age. The death certificate gave the cause of
death as “pellagra.” One of us (W. A. E.)
saw her in this fulminant rapidly fatal attack
of pellagra. She never had any symptoms of
progressive muscular dystrophy. There is no
tradition of any case of muscular dystrophy
in any member of the Ray or Pickle families
and the families have lived for several genera-
tions in this neighborhood.
Family Relations
In the case of the Moffett children, a super-
ficial investigation of the family connections
for five generations results as follows:
There is no family tradition of progressive
muscular dystrophy in the Malone or Phillips
families or any of their forbears or relations.
This was the first generation developing the
disease and the study covered superficially
generations back of it.
In this generation, one ease developed and
that is the youngest of seven children. In this
generation, a Carter had married a Malone.
There is no tradition of any other cases in
Mr. Carter’s family or any of his forbears or
relations. Of the children of the group of
eleven, one son had progressive muscular dys-
trophy and three daughters were the mothers
of children who developed the disease.
In the next generation, two of the Carter
sisters married Mr. Meek, one son of each sis-
ter developed the disease, a son and daughter
of the first wife escaped the disease, but the
daughter bore three sons that developed it.
Of the second wife, a son developed the disease
and a daughter and two sons have escaped
it. Mr. Meek says no progenitor of his or
other relatives ever developed it. A Carter
daughter married Mr. Tubb. Of the three Tubb
sons, two developed the disease, one escaped.
The four Tubb daughters escaped as have their
children up to date. Mr. Tubb says that no
progenitor of his ever had the disease.
In the next generation, a daughter of Mr.
Meeks married Mr. Moffett. Three of their
sons have developed the disease. Mr. Moffett
says that no progenitor of his has ever had
progressive muscular dystrophy. In this, the
Moffett family, and their progenitors for at
least three generations, we find cases of pro-
gressive muscular dystrophy as a familial
sex linked disease affecting males only, trans-
mitted only through non-affected females.
In each generation about one-half of the
males escape and they never pass the disease
on to their progeny. The affected males have
no children. In each generation all of the fe-
males escape the disease, but about one-half
the females pass the disease on to their male
children.
In the Pickle-Ray family the disease does
not appear to be inheritable in either the di-
rect or indirect sense. The case is a female.
Discussion
These are cases of progressive muscular
dystrophy most of them of the familial type,
sex-linked transmitted by clinically healthy fe-
males to about half of their sons. The disease
appears to a recognizable symptomatic extent
of about five to ten years of age and death
terminates life in the middle twenties or be-
fore. The affected males do not beget chil-
dren.
In the Pickle-Ray case, the person affected
was a female. It was not passed on. Other
than its sex relations and its familial character-
istics, this case was identical with the other
cases.
Etiology
No adequate cause of this syndrome is
known. We limit ourselves to a discussion of
one of the contributing causes.
Inheritance
Davenport says whenever the male parent
is characterized by the absence of some charac-
ter to which the determiner is typically lodged
in the sex chromosome a remarkable set of
inheritances is to be expected. This is called
sex limited inheritance. The striking feature
of this sort of heridity is that the trait appears
only in males of the family; is not transmitted
by them, but is transmitted through normal
females of the family. Striking examples of
this sort of heredity are found in cases of
multiple sclerosis, atrophy of the optic nerve,
color blindness, myopia, ichthyosis, muscular
atrophy and hemophilia “(Not to mention
normal conditions such as barring in Domineck
and Plymouth Rock chickens, Polacheck says
that growers recognized the hereditary charac-
ter of the disease in 1879).”
372
The Rh Factor as an Obstetrical Hazard — Patterson
July, 1945
A part of the very considerable literature
dealing with this disease centers upon a dis-
cussion as to whether it is a dominant or a
recessive character. iSome hold that it is a
dominant and in those generations in which
it is not found it is present but is so mildly
symptomatic that it is overlooked.
The weight of the opinion is that it is a sex
linked familial disease.
The Rh Factor as an Obstetrical Hazard*
CHARLES W. PATTERSON, M.D.
Rosedale, Miss.
he medical profession had seemingly ad-
vanced to an unprecedented height when,
by the great weapons of blood grouping,
those barriers obstructing the safety of blood
transfusions, were thought to have been sur-
mounted. But, with the growing popularity
of this life-saving method, many explosive re-
actions began to occur from the mixing pot of
those two liquids that normally should have
been compatible and the increased scientific
investigation which followed soon uncovered
many interesting facts.
At Bellevue Hospital in 1937, a patient with
pre-eclampsia was delivered of a macerated
fetus and given a blood transfusion from a
donor of the same type. The transfusion was
followed by a severe reaction. After investiga-
tion Philip Levine and his co-workers found
that the patient’s blood contained an atypical
glutinin which agglutinated about eighty per
cent of all blood in this group.
In 1940, Landsteiner and Wiener discovered
the Rh factor, the name being selected from
the first two letters of the word “rhesus”
(Rh). They derived an immune agglutinin
which could be produced in rabbits or guinea
pigs by repeated injections of the red cells of
the rhesus monkey. By using this rabbit or
guinea pig immune serum and suitably mix-
ing it with human red blood cells, they were
able to subdivide each of the four groups of
human blood into two classes; the Rh posi-
tive and the Rh negative. If there is an ag-
glutination similar to that which occurs when
the red cells from the rhesus monkey are
mixed with the immune serum, it is known as
positive Rh blood. If there is no agglutination,
then it is negative Rh blood. The Rh factor is
inherited as a Mendelian dominant, and it is
either heterozygous or homozygous, depending
upon whether inherited from one or both par-
ents.
Since the discovery of the Rh factor and
the elimination of many preventable reactions
that were caused from blood transfusions, our
efforts should be focused now on the dangers
confronting the mothers and infants when an
Rh negative woman is married to an Rh posi-
tive man. Frequently the Rh negative mother
carries her first Rh positive baby to term and
a successful delivery of a healthy child. The
first pregnancy usually builds up a small per-
centage of antibodies in the mother, and then
each succeeding pregnancy increases the im-
munization which produces more anti-agglu-
tinins in the mother until the titre of Rh anti-
bodies is raised to the level that produces
erythroblastosis fetalis. Since the Rh factor
is only present in the red blood cells, there
must not only be an intermingling of the ma-
ternal and fetal blood through the placental
barrier, but an actual passage of the red
blood cells from the mother to the fetus and
the fetus to the mother, so that when the fetal
red blood cells enter the maternal circulation,
the action is as an antigen and causes the de-
veloping of the anti Rh agglutinins which must
then pass through the placenta to the fetal
circulation with hemolysis of the fetal red
cells and the development of the disease entity
of erythroblastosis fetalis. If the father is
heterozygous there is a slight possibility that
the fetus will not contain an antigen and there-
fore could not be agglutinated, which makes it
possible for an Rh negative mother, when
bearing twins, to have one entirely normal
child and the other die from erythroblastosis
fetalis.
Having recently had experience with a very
interesting case, I will next give the case re-
port.
July, 1945
373
Case Report
Mrs. K. O. S. : Color white, female, age 30
years, married eight years. Past health has
been exceedingly good, only having had the
usual childhood diseases such as measles,
mumps, chicken-pox, and tonsillectomy. A com-
plete obstetrical record of this case will be
presented that you may observe the manner
in which the Rh factor, slowly but surely,
works its hazard through multiple pregnancies
of the Rh negative woman married to an Rh
positive man. This woman has been pregnant
three times and is the mother of two healthy
living children and two dead infants.
First Pregnancy: On March 21, 1939, af-
ter a normal nine months pregnancy, she was
delivered of a normal baby boy weighing seven
pounds, four ounces. At the present time he
is living and in good health.
Second Pregnancy: From the beginning she
suffered with more than the usual complaints
of pregnancy until May 1942, when five
months had lapsed, I was called and found her
suffering from severe pains with intervals of
about three minutes between uterine contrac-
tions. After treatment and several weeks’ rest
in bed, she went to term and was delivered on
September 17 of twin girls weighing six pounds,
the larger, and four pounds twelve ounces, the
smaller. Within forty-eight hours both babies
showed slight jaundice, but while the larger
soon became normal, the smaller continued
to become more jaundiced and anaemic until
death, which occurred on the fourteenth day, re-
gardless of special nursing care and treatment.
Third Pregnancy: The first examination on
March 20, 1944, revealed a three-month preg-
nancy and a very anaemic patient with a blood
pressure of 96/50. After internal administra-
tion of liver extract and iron to April 11, the
laboratory report showed hemoglobin, 80 per
cent, total red cells, 3, 500,000; white cells,
6,800: small mononuclear, 30 per cent; large, 4
per cent, neutrophils, 60 per cent; malaria
negative; urine, normal. Following this report,
the liver extract was given by needle for
several weeks which caused her to appear and
feel much improved even though the blood
pressure continued at the same level of 98/52
until July 7, when it suddenly went to 130/80
with the urine very dark amber-colored but
otherwise negative. After twenty -four hours
of absolute rest in bed, strict diet, treatment
with no improvement, and a laboratory re-
port of hemoglobin, 60 per cent; red cells,
3,100,000; white 10,000; small mononuclear,,
22 per cent, neutrophils, 74 per cent; urine,
negative chemically and microscopically but
very dark in color, I decided to call Dr. E.
R. Nobles in consultation.
After a thorough study of the case, we de-
cided that she should be given a blood trans-
fusion, so July 9, from a properly typed and
cross matched donor, 500 cc. of citrated blood
were given and completed at 11:00 a. m. At
11:45 she had a hemolytic reaction with rigors,
excruciating pains of the head, extremities, and
over the cardiac region, also the sensation of
a vise compressing the thorax with difficult
respiratory action. Examination revealed a
very irregular weak heart which gradually be-
came normal after the administration of adren-
aline, morphine, and oxygen. Following a very
restless afternoon, although slightly over six
months pregnant, she was delivered at 11:00
p. m. of a dead female [baby with the appear-
ance of having no blood in the body and an
extremely large pot belly, also ecchymotic
spots on the buttocks, legs, and arms, with
slight edema. The placenta was not only tre-
mendous in size but had the consistency of
jelly. The total amount of a twenty-four
hours’ specimen of urine, to July 10, was only
two ounces and contained blood, pus, albumin.
She was then given 1,000 cc. of 10 per cent
dextrose solution intravenously twice daily un-
til there was a sufficient daily output from the
kidneys. But on July 16, because of continued
nausea, vomiting, pains in the head, and
elevated temperature, Dr. Nobles and I de-
cided, after a thorough examination, that she
was suffering from a localized peritonitis, al-
though delivery was accomplished without a
vaginal examination, so we began a treat-
ment of 10,000 units of penicillin every three
hours intramuscularly. She seemed very much
improved on July 18, but the following day a
general peritonitis had developed and with it
a very ill patient. It was than that 100,000
units of penicillin were given in 1,000 cc. nor-
mal saline solution by the drop method in-
travenously and completed after a period of
three hours. At this time, Dr. R. A<. Gamble
arrived and, after consultation, we agreed to '
continue the penicillin in 20, 000-unit doses in-
tramuscularly every three hours and also give
daily treatments with the Elliott machine.
374
The Rh Factor as an Obstetrical Hazard — Patterson
July, 1945
The improvement was very gradual until she
fully recovered and was discharged from the
hospital on July 30.
Laboratory tests showed the blood of the
father and the donor to be Rh positive, but
that of the mother, having Rh positive cells
from the donor in the circulation when sent
to the laboratory reacted against the anti-Rh
testing serum, as always happens, so the blood
must be classified from the past clinical rec-
ord.
If we consider the normalcy of the first
pregnancy and child, the abnormalcy of the
second with the death of one twin presenting
all the symptoms of erythroblastosis fetalis,
then the last pregnancy and the hemolytic re-
action from an Rh positive blood transfusion
followed by the birth of a six-and-one-half-
month dead baby with erythroblastosis fetalis,
surely there could be no doubt as to this
mother having Jth negative blood. It is also
a clinical fact that the father is heterozygous;
otherwise, one twin could not have survived.
CONCLUSION
I will endeavor to enumerate a few of the
recent trends of thought.
I. Eclampsia is related to a blood incom-
patibility of the fetus and mother. The fetal
erythrocytes being agglutinated in the ma-
ternal circulation by specific agglutinins pro-
duced by the immunized mother cause liver
and kidney damage with the ensuing symptoms
of pre-eclampsia and eclampsia.
II. If an Rh positive mother carries an
Rh negative fetus the Rh antibodies may enter
the maternal blood and destroy the red cells,
causing a post-partem anemia.
III. The Rh factor is an antigenic substance
similar to others previously discovered and
occurs only in the red cells, also there are no
normal agglutinins against it.
IV. It is thought that placental injuries are
the cause of the passage of red blood cell3
from the one to the other, but I believe it is
the action of the antibodies and antigenic sub-
stances within the placenta that creates the
degenerative change by which this passage
is accomplished.
V. Eighty-five per cent of all persons are
Rh positive and cannot be immunized against
the Rh factor. However, the fifteen per cent
belonging to the Rh negative classification and
occurring equally between the two sexes may
acquire specific anti-immune bodies, and be-
cause of this fact serious complications may
develop. Pregnancy and repeated transfusions
increase the Rh agglutinins, but pregnancy
provides a far better antigenic stimulus than
repeated transfusions.
The Rh positive fetus must inherit the factor
from the Rh positive parent or the antigen-
antibody response will not occur in the fetus.
VI. If an Rh negative woman is married to
an Rh negative man and is impregnated with
an Rh negative baby, then the antigens being
of the same group will be neutral and not
cause a hemolytic reaction, so she will give
birth to a normal Rh negative child.
The same results will be had if repeated
blood transfusions are given by properly
matched and typed blood of the same Rh
group.
Artificial insemination of the same Rh
group, where the mother is Rh negative and
father Rh positive, will prevent erythroblas-
tosis.
All higher motives, ideals, conceptions, sen-
timents in a man are of no account if they do
not come forward to strengthen him for the
better discharge of the duties which devolve
upon him in the ordinary affairs of life.
— Henry Ward Beecher (1813-1887)
Thiouracil*
A. STREET, M.D.
Vicksburg, Miss.
Kennedy and Purves in 1941 showed that
rapeseed and ally! thiourea are potent
goitrogens. Later the MacKenzies and Mc-
Collum and Astwood showed that thiourea and
thiourea derivatives, especially2 thiouracil, pro-
duced morphologic hyperplasia, associated with
inhibition of thyroid function1 and Astwood
employed thiouracil in the treatment of pa-
tients with toxic goiter.
There is now ample evidence that thiouracil
can be depended upon to reduce thyroid ac-
tivity of both the toxic and normal patient.
The drug seems to stop the production of the
thyroid hormone. Thyroxin already present be-
fore stopping production is very slowly dis-
posed of by the body processes, and therefore
considerable time may be expected to elapse
between the beginning of medication and the
fall in metabolic rate. In dealing with toxic
patients it usually requires three to eight
weeks for the rate to fall within normal range.
Unfortunately the drug has serious proper-
ties which have been manifest in five to twenty
per cent of reported cases. The most serious
toxic reactions are the result of bone marrow
damage and consist of agranulocytosis, granu-
locytopenia and leukopenia. This type of re-
action may be incontrollable and fatal cases
have occurred. However, the more serious type
of toxic reaction is comparatively infrequent
and the majority of reactions are not so im-
portant. They include jaundice, drug fever,
swelling of submaxillary salivary glands,
dermatitis, arthritis and arthralgia, oedema of
legs, nausea and vomiting, and diarrhoea.
Williams and Clute2 report results in the
use of thiouracil in the management of 152
hyperthyroid patients, fifty-nine of whom were
subjected to subtotal thyroidectomy after con-
trolling the symptoms with thiouracil. Some
patients with malignant exophthalmos showed
an exacerbation of that symptom shortly after
starting thiouracil. This was successfully com-
batted by giving dessicated thyroid in con-
junction with the thiouracil. Dessicated thy-
roid was also found to have a tendency to re-
duce the size of the thyroid gland. Iodine was
administered along with thiouracil to some
patients pre-operatively in order to diminish
vascularity of the gland at operation. Thiamin
and brewers’ yeast were added to the treat-
ment in an attempt to combat the possibility of
leukopenia. The size of the gland and the micro-
scopic picture of the toxic thyroid is not al-
tered by thiouracil.
Our own experience with thiouracil has so
far been very satisfactory. Of fourteen cases
treated there has been only one toxic reaction
which consisted of slight fever and skin erup-
tion. Toxic thyroid symptoms have been well
under control after three or four weeks of
medication, subtotal thyroidectomy has been
well tolerated, postoperative crises have been
absent, and vascularity of the gland has not
been troublesome. Frequent clinical observa-
tions and blood examinations have been done
during thiouracil treatment.
Thiouracil does not seem to be a medical
cure for hyperthyroidism. It does not attack
the cause of the disease, but it does stop the
synthesis of the thyroid hormone and controls
the symptoms. On stopping the drug the symp-
toms will recur. It does not seem wise to con-
tinue the drug indefinitely because of its toxic
properties. Except for the small but definite
risk of serious toxic reaction thiouracil seems
to be the most efficient drug yet developed for
the control of hyperthyroid symptoms and for
preparation of thyrotoxic patients for surgical
treatment.
BIBLIOGRAPHY
1. Gargill, S. L. and Lesses, M. F. : (‘Toxic Reactions
to Thiouracil,” J.A.M.A. 127: 890 (April 7) 1945
2. Williams, R. H. and Clute, H.M. : ‘‘Thiouracil in
the Treatment of Thyrotoxicosis,” J.A.M.A. 218:
65 (May 12) 1945.
When egotism goes out, true philosophy en-
ters the soul.
— Anderson M. Baten
375
376
Editorials
July, 1945
The Mississippi Doctor
Published monthly at Booneville, Mississippi
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 187u. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
Official Organ Of
Mid-South Postgraduate Medical Assembly
Mississippi State Medical Association
W. H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
Mid-South Postgraduate Medical Assembly
Officers :
C. H. Lutterloh, M. D. President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M. D Vice-President
El Dorado, Ark.
A. F. Cooper Secretary-Treasurer
Memphis, Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis. Tenn.
Editors :
Fay H. Jones, M.D. E. M. Holder, M.D.
C. R. Crutchfield, M. D. C. M. Speck, M.D.
H. King Wade, M. D. F. M. Acree, M.D.
Mississippi State Medical Association
Editor
Lawrence W. Long, M.D.
Associate Editors
J. G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life Building,
Jackson. Mississippi.
TO HAVE OR NOT TO HAVE
About the most important question before
the people of Mississippi right now is whether
to have a four-year medical school or not to
have one. For forty-two years this state has
had what has been recognized as one of the
best two-year schools in any state. Not long
ago there were ten two-year medical schools
in the United States, but only three or four
are now left, the others having been advanced
to four-year schools or subsidized by another
school. Some claim we do not have the clinical
material for the other two years, but this is
not true. It is not the number of clinical pa-
tients that counts; it is how well the few are
utilized for teaching purposes. Mississippi has
a per capita distribution of funds for the in-
digent sick. This is the biggest step forward
ever made for the rank and file. And with a
central hospital and medical school used as a
means to apply medical service, clinical ma-
terial from all over the state could be utilized
for teaching purposes, all that is needed. Of
course there must be an affiliation between the
central hospital and all hospitals of the state.
Interns might serve their last six months in
the smaller hospitals over the state, making
calls with practitioners who know clinical medi-
cine, and finally find a place of leadership
in the small town. In the big centers today
interns are taught so much in terms of ex-
pensive operating rooms, nurses, assistants,
number and chart system of management,
limited office hours, and big fees, that it is
impossible to induce one to return to the
country.
With the hospital system we have, insurance
could be made available to the entire state, or
a large portion of it. Many believe that we
have to have a five-hundred-bed hospital if it
it is to be operated economically. What about
the expense to the patients who travel all this
distance to the hospital ? Here is where the one-
sided economist comes in. Nevada has the
highest number of beds per population in the
union, but poorly distributed, and she has the
highest death rate for appendicitis in the na-
tion, more than twice that of Mississippi. Dr.
Time is the most successful surgeon this coun-
try knows for acute appendicitis and many
other conditions. Therefore a system of small
hospitals and a plan of education for the laity
will eventually assure an operation for acute
appendicitis within six hours of the onset.
It is not the big hospital that we need; it
is a better distribution of beds and the avail-
ability of them to the very sick patient. Fur-
thermore eighty-five per cent of the people
of Mississippi get sick and die of ordinary
diseases which should be handled just as well
by eighty-five per cent of the rank and file of
doctors. When both physicians and patients
analyze the specialist’s strategy in “I am the
only one who can do it” and “I must have
July, 1945
377
him in a five-hundred-bed hospital so more in-
terns can see- me operate” it becomes obvious
that his method is self-advertising. The time
has come, medically speaking, that the people
need to be able to get just a plain shave in-
stead of a lot of expensive mud massages. A
hospital in Mississippi does not have to be
equipped for every kind of therapy known,
nor does the medical school. Richmond, Ro-
chester or Boston may still have a chair for
aneurysm of the circle of Willis or Simmond’s
disease. We shall continue to affiliate medical-
ly with the rest of the world, even if we do
have a medical school to serve ninety-five per
cent of our population.
Others say, Give us a better hospital system
first and then some time you can have the
four-year medical school. Yes, but we have
about decided now that we have waited forty-
two years too long for a four-year medical
school. A post office that does not deliver mail
out to the folks on the rural route would not
be tolerated; and yet we have a lot of medical
schools that are content with just giving a
diploma. Mississippi can have a school that
can show the way to a better day in medicine
for the people. If Tennessee can have three
schools, Louisiana two, and Virginia two, why
can’t we have one? The Lord is pouring out
the oil in our state maybe just for this purpose.
We have thirty millions in cash, and we al-
ready have the best distribution of hospitals
in the United States although they need to be
improved a lot.
Some few seem to be afraid of a central
hospital at Jackson. This is false fear. The
idea we have of a four-year school and a hos-
pital affiliation will help every doctor in the
state, every town and every individual. The
system we are thinking of will give more
practice to every doctor and better service to
every individual.
Our state is now drained from every side
of the best practice, but with the proper ex-
tension consultant service this would not be
the case.
If our two-year school has to go, which we
think it will probably soon, then we shall
be indebted to other states as far as training
our fine boys is concerned.
Last fall we asked Dr. Fishbein what he
thought of our state having a four-year medi-
cal school and he replied, “If we are to con-
tinue to have states as units of government, I
think you should have it.” We considered this
statement fine food for thought.
It has been suggested that we send our
Negroes up in Tennessee and get some Negro
doctors “which is about all we need.” A few
good Negro doctors would be fine, but have
we stopped to think that our Negro population
might not remain as it is very long? Finger
picking of cotton is on its way out and indus-
try in Mississippi is already in. This may
change the color of our population.
Anyway we think Mississippi should have a
four-year medical school used as a means to
an end and the end would be to build total
health assets, mental, physical, and spiritual
in all the people.
§
Dr. Seale Harris, the spirit of Southern medi-
cine, is writing a book on Dr. Marian Sims of
Alabama, the father of gynecology. Every
doctor will be anxious to have a copy of this
book as well as his book on Dr. Banting. Dr.
Harris has prepared an article on the life and
work of Dr. Sims for the Alabama State Medi-
cal Journal and he has very kindly sent it to us
also. Our readers will be delighted to read what
Dr. Harris has written on this international
character in the field of gynecology. This will
appear in the August and September issues of
The Mississippi Doctor.
The casualty list among our doctors in civil
life is keeping step with the rate on the battle-
field. It is probably exceeding the combat list.
Our doctors have displayed great patriotism
and loyalty to duty and determination of pur-
pose in their efforts to hold the civil firing
lines in practice while their younger fellow
doctors do their duty in a wonderful manner
in the battle arena. Glory and honor to them.
In the death of Dr. S. J. Wolferman of Fort
Smith, Arkansas, the Mid-South lost a fine
spirit in the field of medicine. He was able in
his profession, cordial in his relations to his
fellow doctors, and always ready to give liber-
ally of his time to organized medicine. Dr.
Wolferman served on the council of the South-
ern Medical Association, and was always active
in the Mid-South Postgraduate Medical As-
sembly. He was a delightful man to know,
reasonable, cordial, and fair-minded. We deep-
ly regret his going.
§
New Orleans has long set a pace in Southern
medicine. Dr. Rudolph Matas is the medical
sage of New Orleans, the dean of the surgical
378
Editorials
world, the master medical spirit of the last
half century. But there was another in New
Orleans, one very popular, very efficient, very
able and self-sacrificing, Dr. James T. Nix,
whose untimely death is mourned. Loved and
revered, he was a great inspiration to the
profession. He truly possessed the heart, the
spirit and the mind of a true doctor, a great
surgeon. He was not only loved in his own
city, but he was known and admired through-
out the South. A great surgeon, an able writer,
and a powerful Christian spirit has left us,
truly another war casualty. We are happy to
have claimed him as a friend, and to have felt
the power of his personality.
Dr. M. Y. Dabney, president-elect, Southern
Medical Association, Birmingham, has an-
nounced his appointments to the Council, ef-
fective at the close of the annual meeting in
November. From now until the annual meet-
ing these names will be carried on the official
roster as councilors-elect.
Florida — Dr. William C. Thomas, Gainesville,
to succeed Dr. Walter C. Jones, Miami.
South Carolina — Dr. W. L. Pressly, Due
West, to succeed Dr. J. Warren White, Green-
ville.
Texas — Dr. Walter G. Struck, San Antonio,
to succeed Dr. Curtice Rosser, Dallas.
Virginia — Dr. T. Dewey Davis, Richmond,
to succeed Dr. Thomas W. Murrell, Richmond.
SOUTHERN MEDICAL ASSOCIATION
EXECUTIVE COMMITTEE MEETING
The Executive Committee of the Council of
the Southern Medical Association met at the
Tutwiler Hotel, Birmingham, Monday, May 21,
and went on record as favoring the usual an-
nual meeting this year unless conditions in-
dicate that a meeting should not or could not
be held. The Executive Committee named a
committee of three to handle a request to
the Office of Defense Transportation for per-
mission to hold the regular meeting in Novem-
ber. Members of this committee are Dr. Oscar
B. Hunter, chairman, Washington, D. C. ; Dr.
James S. Simmons, Brigadier General, Medi-
cal Corps, U. iS. Army, Washington, D. C. ;
and Mr. C. P. Loranz, secretary and general
manager, Birmingham, Alabama.
It was decided that it would not be proper
in these war times to have non-medical ac-
tivities, social, semi-social or entertainment
activities. If the meeting is held in November,
there will be no president’s reception and ball,
no alumni reunion dinners, no fraternity lunch-
eons and no golf or trapshooting tournaments.
There will also be no meeting of the Woman’s
Auxiliary, since it is a semi-social organization.
All Auxiliary officers will be held over until
another year.
Two of the distinguished physicians attend-
ing the Executive Committee meeting of the
Southern Medical Association presented papers :
Dr. Curtice Rosser, Dallas, Texas, “The In-
fluence of Race on Ano-Rectal Diseases,’’ and
Dr. Oscar B. Hunter, Washington, D. C., “The
Clinical Significance of the Rh Factor.”
MEDICAL SEMINAR
An illustrated lecture seminar integrating
the patho-physiological reactions of the hu-
man being to the environment, and covering
a wide range of medical problems of interest
to the practicing physician, will be conducted
by Dr. William F. Petersen commencing Mon-
day September 17 and extending through Sep-
tember 22. Sessions will be held from 9:30 to
4:30 each day in the Conference Room of the
Institute of Medicine, Chicago. Detailed infor-
mation, program, registration applications,
can be obtained from the Secretary, Institute
of Medicine of Chicago, 86 Randolph Street
(Crerar Library Building) Chicago, 111.
All the people in our state deserve medical
service. All can have it just like they have
daily mail, farm service, public education,
hard-surface roads and electric lights. They
will if we establish a medical school to be used
as an end, the object being to give all the
people the best possible in medicine. The big
medical schools have been too largely satisfied
with just issuing a diploma and have not yet
caught the vision of medical service to the
people.
ANNOUNCEMENT
The Vicksburg Hospital, Inc., and the Vicks-
burg Clinic announce the appointment of Dr.
Robert M. Moore, professor of pathology and
clinical laboratory, University of Mississippi,
School of Medicine, as pathologist and director
of clinical laboratories, June 4. 1945.
It is said that a river becomes crooked fol-
lowing the line of least resistance. So does
man.
July, 1945
Deaths
379
Deaths
dr. J. T. NIX
Dr. James T. Nix, New Orleans, Louisiana, died
in May of this year at the age of 58. He was a
graduate of Tulane University, (M.D.), Loyola Uni-
versity (M.A., LL.D.). Dr. Nix served on the surgi-
cal staff with Dr. Rudolph Matas several years,
professor of surgery of Loyola, dean of Louisiana
State Medical School, held many important civic and
professional connections, member of numerous fra-
ternities and medical societies, author of several
treatises, poems and scientific articles. Dr. Nix was
one of the most devoted of men to his profession, and
one of the most beloved.
Dr. Nix is survived by his wife, a son and a
daughter.
DR. WALTER FRANK COLEMAN
Dr. Walter Frank Coleman died June 12, 1945, at
his home at Hickory Flat, Mississippi, at the age
of 60. He had been ill several months.
Dr. Coleman was born at Wallerville, Mississippi,
was graduated from the University of Tennessee
School of Medicine in June, 1915. He practiced medi-
cine in Tennessee before moving to Mississippi. He
was a leader in religious and civic activities besides
having served as president of the North Mississippi
Medical Society in 1939.
Surviving are his wife, Mrs. Ada Caldwell Cole-
man, a brother, I. M. Coleman, of Columbus, Miss.,
and a half-sister, Mrs. Clara Cornelius of Texas.
DR. SAMUEL H. HOWARD
Dr. Samuel H. Howard died at the home of his
daughter, Mrs. Pugh Winborn, Durant, on June 19,
1945. He was 81 years of age. A pioneer citizen of
Durant, Dr. Howard practiced medicine at A. & M.
College for eight years, then operated a hotel for
a number of years. He was a graduate of Memphis
Hospital Medical College, Memphis, Tennessee.
Dr. Howard is survived by his daughters, Mrs.
Winborn, and Mrs. E. H. Archer, of Nebraska; and
two sons, D. M. Howard and B. H. Howard, of
South Carolina.
DR. CLAUDE T. KEYES
Dr. Claude T. Keyes, born at Fulton, in 1870,
died May 7 during an operation at a hospital in
San Angelo, Texas. He was a member of one of the
pioneer families of Lee and Itawamba Counties, a
graduate of Memphis Hospital Medical College. He
moved to Texas in 1911, and carried on an active
practice until his health failed in recent years. He
leaves six children, all living in Texas. Four sisters
also survive: Mrs. D. S. Ballard and Mrs. George
Thompson, both of Tupelo; Mrs. Wylie Frances of
Nettleton and Mrs. Lige Ballary of Dallas. Services
were held in San Angelo.
DR. C. M. DAVIS
Dr. C. M. Davis, 76, pioneer Laurel physician,
died May 22.
Dr. Davis came to Laurel from Louisiana at
the age of 24 soon after completing his medical
training and had practiced there ever since. Dr.
Davis was a graduate of Vanderbilt University, Nash-
ville, Tenn. He operated a large clinic for several
years. He leaves his widow and two sisters, Mrs.
N. P. Vernon, Amite, La., and Mrs. A. W. White-
man. New Orleans.
DR. C. W. PATTERSON
Dr. Charles W. Patterson, who practiced medi-
cine in Pontotoc and adjoining counties for many
years, died at Grenada Hospital. He was 73 years
of age. He was living at Crowder when he became
ill. He received his education at Memphis Medical
College, Memphis, Tenn., and was licensed in 1907
to practice in Mississippi.
Burial was at Pittsboro following services at Cal-
houn City. Dr. Patterson was a member of pioneer
families of Calhoun County.
DR. C. E. BOYD
Dr. C. E. Boyd, of Hatley, died of a heart at-
tack at the Baptist Hospital in Memphis Saturday,
June 9, after an illness of only a few days, although
he had been in a run-down condition from over-work
for sometime.
The- last rites were held from the Quincy Bap-
tist Church Sunday morning at 10 o’clock, with burial
in Quincy Cemetery. He was a member of the Amory
Baptist Church. Born at Quincy in 1882, he was
married in 1905 to Eda Phillips, who survives. In
1911 he graduated from the Medical Department of
University of Alabama, which was located in Bir-
mingham. That same year he moved to Hatley where
he has been a popular practicing physician until
he was forced to take his bed a week before he died.
Two children survive, Olga Boyd, of Hatley, and
Mrs. Dixie Brewer, of Amory. He leaves two grand-
children, Claude and “Kim” Boyd. Brothers surviving
are Ethel and Floyd Boyd of Quincy, and Wayne
Boyd of Dancy, Alabama.
DR. EDWARD A. GRICE
Dr. Edward A. Grice, 64, who died at his home
in Epps, La., was buried at Palestine.
He spent his early life in Clay County, where
he practiced medicine at Montpelier.
Survivors include his wife, Mrs. Nora Murry
Grice, of Epps, La., one son, Wilson A. Grice of
Point LaHash, La., two grandsons, Billy and Sonny
Grice, and one sister, Mrs. Lillian Skinner of Cleve-
land, Texas.
DR. S. G. SCRUGGS
Funeral services for the late Dr. S. G. Scruggs,
who died in Memphis, were conducted from the First
Methodist Church. Burial was in Odd Fellows Ceme-
tery, following funeral service.
Dr. Scruggs was 96 years old and practiced in
Grenada as a specialist for many years, before going
to Memphis in 1934 to reside with his daughter,
Mrs. J. L. Findley.
God will not look you over for medals, de-
grees or diplomas but for scars.
The longer I live, the more deeply am I con-
vinced that that which makes the difference
between one good man and another — between
the weak and powerful, the great and insig-
nificant, is energy — invincible determination —
a purpose once formed, and then death or
victory.
— Fowell Buxton (1786-1845)
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology— Karl O. Stin-
gily, Meridian.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
DERMATOLOGY
Archives of Dermatology and Syphilology,
V. 51; No. 4; April, 1945, page 272.
Treatment and Prevention of Dermato-
PHYTOSIS AND RELATED CONDITIONS. Joseph G.
Hopkins, Arthur B. Hillegas, Earl Camp, R.
Bruce Ledin and Gerbert Rebell, Bull. U. S.
Army M. Dept., June 1944, No. 77, p. 42.
The work described in this paper was done
under a contract, recommended by the Com-
mittee on Medical Research, between the office
of Scientific Research and Development of the
National Research Council and Columbia Uni-
versity. The findings, which should not be con-
sidered final, are stated somewhat categoric-
ally for the sake of brevity.
Inflammation of the skin of the feet may re-
sult from many causes, of which the follow-
ing were recognized by these authors: mycotic
infection, pyogenic infection, allergy, hyper-
hidrosis, trauma and hypostasis.
The authors stress two principals of treat-
ment: (1) hygienic measures, such as cleanli-
ness, dryness and aeration of the areas in-
volved and elevation of the feet to relieve
hypostatic congestion, and (2) active treat-
ment as such, which must avoid injury and
vary with the causation and type of involve-
ment. Fungi have been found in about 70
per cent of cases on intertrigo of the toes
and in over 90 per cent of dyshidrotic lesions
on the soles. The most effective treatment
agents in such cases are those which attack
the fungi. In general, iodine, a number of mer-
curials, thymol, and several essential oils have
seemed low in effectiveness and irritating in
a significant number of cases. The dyes, too,
appeared weakly fungicidal according to these
investigators. Of the familiar fungicides, ben-
zoic acid, salicylic acid and sulfur were the
most useful drugs. Ointments should be used
only at night and wiped off thoroughly in the
morning and a powder applied to the toes.
The addition of 10 to 25 per cent bentonite
to talc powder increases its absorptive quality.
In cas&s of a simple intertrigo, an ointment
or paint should be applied to the sides and
webs of all the toes and the entire sole every
night until the skin appears normal and should
also be applied once a week throughout the
warm season, to prevent relapse. A benzoic
acid paint is recommended among others, the
formula for which is benzoic acid 5 gm. acetone
15 cc. and cotton seed oil 85 cc. For obsti-
nate infections sulfur and salicylic acid oint-
ments are recommended. For fissured and
denuded areas an ointment of zephiran chlo-
ride (10 per cent) 5cc., water 22 cc., hydrous
wool fat 25 cc. and petrolatum 50 cc., was
very useful. For some obstinate infections, 5
per cent sulfathiazole ointment succeeded when
zephiran ointment failed to bring improve-
ment. Potassium permanganate baths are
recommended (about 1:4,000) for acute or
overtreated dermatoses with dyshidrotic les-
ions on the soles. Zephiran (200 cc. of 10 per
cent concentration of zephiran chloride) in 2
liters of water proved to be a very effective
non-irritating foot bath.
The follow-up treatment after the active
lesions have subsided is stressed and consists
of hygienic measures and fungicidal paints.
Anychomycosis was treated by thorough re-
moval of all portions of the nail that had be-
come friable or loosened from the bed, and
a chrysarobin paste was used among others.
A satisfactory paint for lesions of the groin
and trunk that are not eczematized is rec-
commended. It consists of salicylic acid 3
gm. and tincture of merthiolate (1:1,000) 100
cc.
The authors discuss at length the symptoms
and treatment of local hyperhidrosis and
stress the importance of prophylaxis. There
are numerous formulas in this paper which
can not be given here on account of space.
Physicians who know how difficult it is at
times to treat dermatophytosis will appreciate
the excellent report.
Trench Foot. Robert C. Berson and Ralph
J. Angelucci, Bull. U. S. Army M. Dept., June
1944, No. 77, p. 91.
The critical temperature for cooling tissues
according to Berson and Angelucci appears to
July, 1945
Interpreting Medical Literature
381
be in the region of -5° to -7°. Tissues cooled
below this temperature are killed.
The term “frost bite” should be reserved
for the condition in which tissues have been
cooled below the critical temperature, while
the term “trench foot” should be reserved
for feet which show evidence of damage due
to cooling above the critical temperature, ac-
cording to these authors.
In the 144 cases of trench foot studied by
Berson and Angelucci there was presumptive
evidence that a past history of symptoms
from exposure, a family history of diabetes
and hypertension and a past history of
smoking were not important predisposing fac-
tors.
A series of 88 consecutive patients was di-
vided into three treatment groups. The first
group was given a regular hospital diet, ab-
solute rest in bed and as much codeine as
required to keep them fairly comfortable.
The second group was in addition given Buer-
ger’s exercises four times daily. The third
group was given no exercise but was given
50 mg. of thiamine hydrochloride hyperdermi-
cally twice daily. There was no demonstrable
significant difference in the comfort, the a-
mount of sedation required or the rate of re-
covery in the three groups.
The following suggestions for early treat-
ment were given: 1) removal of all potentially
constricting clothing and shoes, 2) prohibition
of walking or weight-bearing on the feet, 3)
immediate application of cooling by the most
efficient method at hand and continuation of
such cooling until its slow withdrawal does
not cause the feet to become noticeably warm-
er than the rest of the body, 4) strict avoid-
ance of all warming agents (clothing, dress-
ing, hot water bottles, stoves, etc), 5) strict
prohibition of all massage. 6) avoidance of
sympathetic block at the early stage. Stra-
kosch, Denver.
PEDIATRICS
Alum-Precipitated Diphtheria Toxoid for
Inoculation of Persons Exposed to Whoop-
ing Cough — Munox Turnbull, Jorge. American
Journal of Diseases of Children, 69. January,
1945.
While studying the clinical modification of
whooping cough by the use of alum-precipitat-
ed diphtheria toxoid, the writer had the op-
portunity to observe nine children exposed to
siblings with pertussis who were inoculated
with this toxoid at the time the siblings
began to cough or before, and who were pro-
tected from whooping cough in spite of the
fact that they continued to live with the sib-
lings who had the ailment. This fact at the
time seemed significant, although not conclu-
sive, and induced him to institute observations
of other exposed persons under the same cir-
cumstances. “The fact that the latter subjects
obtained protection by inoculation with alum-
precipitated toxoid supported the idea suggest-
ed by the first nine cases.”
Up to the present time the writer has ob-
served sixty-one exposed children under con-
ditions that do not warrant the slightest doubt
that opportunity for contagion existed, since
all of these children lived in the same houses
and many slept in the same bedrooms as one
or more siblings who had whooping cough.
“In addition, there were four persons ex-
posed to pertussis in whom the disease de-
veloped despite inoculation at the time the
siblings began to cough or before. Although
these persons had a mild form of the disease,
there is no question of protection. However,
the clinical modifications of the disease in
these patients should be noted: Its duration
never exceeded three weeks, and the intensity
of the disease was less than it was in chil-
dren who had not been inoculated.”
The writer proposes the hypothesis of syn-
ergy of two antigens — in these cases, Bacillus
pertussis and diphtheria toxoid — to explain the
improved immunization response. At the pres-
ent time he believes that is how the diph-
theria toxoid acts on children already infected
with whooping cough.
“The criteria used in classifying a child as
exposed were as follows:
“1. One or more of his brothers and sisters
must have whooping cough with all its clinical
characteristics.” These characteristics are: at
least one week of spasmodic cough, vomiting,
congestion of the face during the coughing
spell, and a final loud inspiration.
“2. Another frequent factor of importance
and essential was that of epidemic — the co-
existence of two or more cases of whooping
cough in the same house.
“3. A child was considered exposed if he
had been living intimately with infected per-
sons during the catarrhal period, especially if
the contact was made at the beginning of the
period of spasmodic cough.
“A child was considered protected if he had
been inoculated before or just at the time that
382
State Board of Health
July, 1945
his cough began of course without spasms)
and if he did not cough for more than ten
days.
“The doses of alum-precipitated diphtheria
toxoid used were as follows: 0.5 cc. for in-
fants from birth to the age of 3 months; 1 cc.
for infants from 3 to 12 months old, and 1.5
cc. for those above 1 year of age. The in-
jections were made every week subcutaneous-
ly in the deltoid region, with a maximum of
three injections.”
“Most of the protected subjects who were
exposed to pertussis coughed for several days
after being inoculated, the maximum length of
time being six to ten days. Others did not
cough at all.”
In regard to subjects who coughed for a few
days, it is the writer’s impression that they
were protected in the best possible manner,
because if they had, as a matter of fact, such
a mild form of pertussis that it could not be
recognized were it not for the antecedent pos-
sibility of contagion, then they should have
acquired definite immunity.
“A very important fact is that several of
these children were just a few days or months
old. It is known that the mortality rate is
highest in infants under one year of age, since
at this age complications such as broncho-
pneumonia, encephalitis, and especially con-
vulsive conditions are frequent.”
“Not in all subjects was there complete
absence of cough. However, as regards those
considered protected, if they did cough it was
never for more than six to ten days and al-
ways in a manner that only vaguely suggest-
ed pertussis.” The sixty-one subjects whom
the writer has observed have demonstrated
that the best results are obtained when the
injection of diphtheria toxoid is done during
the period of incubation. “If, on the other
hand, the injections are made in the catarrhal
period, then the disease can be favorably modi-
fied in its evolution and intensity and in the
frequency of the coughing spells.”
COMMENT
This article is of unusual interest since the
study, as well as tests given in this experience
comes from good authority and one can be
assured that there is evidence of good results
from such procedure. The remedy is accessible,
its use very simple, and can be secured and
given by any physician without delay im-
mediately after exposure of the infants to the
disease.
Felix J- Underwood, M .D.
MOUTH HEALTH ACTIVITIES IN
MISSISSIPPI
The considerable number of dental defects
disclosed through selective service examina-
tions has brought into sharp focus the wide
prevalence of such defects among the popula-
tion of draft age individuals. That many of
these defects might have been prevented had
they received proper attention in early life,
there can be no question. A number of fac-
tors are no doubt responsible, such as economic
handicaps in obtaining professional care, lack
of accessibility to a good dentist, poor dietary
habits, ignorance, and lack of personal hy-
giene— much of which might be largely over-
come through improved standards of living,
a better distribution of dentists, and adequate
and effective health education. '
Mississippi has for many years had a very
good program designed to promote better
mouth health. Dr. William R. Wright, dental-
member of the Board of Health for the state-
at-large, serving in this capacity since 1926,
has given unstintingly of his time and abilities
in furthering better mouth health for Missis-
sippians. The close relationship of mouth
health to general health and well-being is
readily recognized in the public health pro-
gram. Dentists and physicians acknowledge
that they have much in common, so close is
the relationship of dentistry to medicine. A
broad knowledge of the important works in
both sciences is essential to the rendering of
good medical and dental care.
Worthy of more than passing note is the
report of mouth health activities covering the
July, 1945
State Board of Health
383
period July 1943, to June 1945, submitted by
Miss Gladys Eyrich, state supervisor of mouth
health of the State Board of Health staff.
“The aim of mouth health activities is to con-
vince the people that it pays to have good
mouths and to help them reach this goal,”
Miss Eyrich points out. Recent objectives have
been: to increase the number of dental hygien-
ists; to make dental hygiene a real part of
county health departments and school pro-
grams; to supply sound mouth health teaching
material; to supplement local funds for the
correction of dental defects; and to work close-
ly with organized dentistry both within and
without the state.
When the mouth health program began in
January 1923, it was planned as an educational
program with the idea of using teachers and
dental hygienists as the instructors. A law
governing the practice of dental hygiene was
passed by the legislature in 1922, and the
first dental hygienist was brought into the
state in 1924. It was never possible to secure
as many dental hygienists as needed. In fact,
during this biennium, the dental hygiene ser-
vice was reduced to 46 per cent of that in the
last biennium.
As an attempt to fill the need for mouth
health workers, the State Board of Health
offered in the summer of 1944, three scholar-
ships of $1,000 each to college graduates for
one year of dental hygiene study. Upon com-
pletion of the course, the applicant signs an
agreement to work for the State Board of
Health for three years after passing the State
Board of Dental Examiners. A graduate of
Mississippi Southern College who is a primary
teacher, received the first scholarship and
completed study in June 1945, at Temple Uni-
versity School of Dental Hygiene in Phila-
delphia.
Mouth health activities were conducted in
forty counties by the mouth health supervisor
and eight dental hygienists. The supervisor
conducted inspections and instruction in twen-
ty-one counties with especial attention to the
urban schools of Hinds, Forrest, Jones and Pike.
Three counties : Coahoma, Washington and
Warren had well rounded programs with full
time dental hygienists. A fourth hygienist, as-
signed to the northeastern district in June
1944, received or continued programs in ten
of the nineteen counties. Three hygienists had
the responsibility of six counties, with occasion-
al brief assignments in other communities.
Work among the Negroes was conducted
chiefly by a Negro dental hygienist who re-
signed December 1944. Inspections, instruction
and prophylaxes were given to children during
the school term and to teachers in the summer
at normals and workshops. The white dental
hygienist in Harrison County worked among
Negro maternity cases at conferences. An all
time high in good mouths was recorded by
the dental hygienist in Leflore County when
80 per cent of 148 Negro preschool children
were found to have mouths in good condition.
Inspections were made of 98,870 mouths;
dental prophylaxis was given to 8,935 persons;
4,116 home visits were made; and 19,319 dental
certificates of completed dental corrections
were reported. Five schools were 100 per cent
in dental corrections and three others were
above 95 per cent. The 100 per cent schools
were : Oakhurst in Clarksdale and all four
elementary public schools in Greenville, where
the Chinese school was the first to reach 100
per cent both years of the biennium. A photo-
graph and an account of this accomplishment
was sent to the dental director of Free China,
and was published in the Dental Survey, the
Journal of the Pierre Fauchard Academy. The
1944 senior class of Riverside School, Wash-
ington County, reached 100 per cent in dental
corrections before graduation. Teacher and
parent interest in classrooms completing their
dental work has increased to the extent that
131 rooms secured all their dental certificates
this biennium as compared with thirty in the
preceding two years.
In the city of Jackson, school monthly
progress cards carry notations about teeth:
O indicates no progress; S indicates a dental
appointment or slow progress; N shows a den-
tal certificate or normal progress. This co-
operation on the part of the elementary schools
is largely responsible for the fact that many
pupils bring two certificates yearly to school,
and that six of the nine schools reached 74
to 91 per cent in good teeth by January.
The dental sections of five new elementary
health texts were reviewed. An error and
several misleading statements were brought
to the attention of the publishers, who stated
that the error would be corrected and other
improvements made in the Mississippi books.
Dental health education materials have been
kept up to date through the purchases or
printing of four new booklets, two leaflets,
a poster and two films. Much of the material
is for use with teachers in the schools, other
pieces are for parents, and some are used by
384
State Board of Health
July, 1945
dentists with their patients. Several thousand
simple fliers on brushing were prepared for
the Emergency Maternity and Child Care pro-
gram. Teaching of mouth health and the ef-
fective distribution of literature have been
facilitated by the workshops for teachers and
courses for health educators, both starting in
this biennium.
Dental clinics were served by sixty dentists
in thirteen counties and included 827 children,
the dentists working 316 hours at an hourly
rate. The State Board of Health matched
funds with the communities on a fifty-fifty
basis. The Parent Teacher Associations, Pnot
Club, Junior Auxiliary, American Legion, and
Business and Professional Women’s Club as-
sisted in the work.
Through such a project reduction in tooth
loss is indicated in Jackson. For nine years,
the Pilot Club sponsored dental corrections
for a small group of indigent children in Lee
School. During dental inspections in September
1944, this school was found to have 3 per cent
of the enrollment who needed extractions of
permanent teeth as compared with 5 per cent
of the enrollment in two other schools of a
similar economic level.
Following a plan suggested by the American
Dental Association for all state dental or-
ganizations, the Mississippi Dental Associa-
tion has a Council on Dental Health, consist-
ing of thirteen members; a chairman, and two
dentists from each of the six district dental
societies. The Council objectives include re-
search in the cause of dental caries and the
promotion of the state mouth health program.
Professional studies indicate that decay of
the teeth, a bacterial disease almost universal
in extent, may be controlled by systematic den-
tal care combined with a diet low in sugars and
starches. To become further acquainted with
such a study, the Council chairman, five Mis-
sissippi dentists and the supervisor of mouth
health attended a forum in New Orleans to
hear the results of certain Michigan investiga-
tions. The Michigan conclusions on the cause
and control of tooth decay have influenced
several states to set up laboratory facilities
to implement a dental caries control program.
Fluorine in drinking water to the amount
of one part per million has been found bene-
ficial to tooth formation. A concentration above
1:1,000,000 results in slight to marked mot-
tling of tooth enamel. The district United
States Public Health Service dental consultant,
Dr. V. L. Hagan, made three visits to the
state, and the dental surgeon of the United
State Public Health Service, States Relations
Division, Dr. John W. Knutson, made one.
Both are interested in the fluorine possibilities.
Dr. Knutson visited Scooba to observe the
operation of the municipal filter which was in-
stalled several years ago to reduce the fluorine
in the water to the safety line of one part
per million. He saw forty mouths among high
school pupils, found very little decay and only
one child with mottled enamel.
Dr. Hagan spoke at state dental and public
health meetings and visited the Newton Coun-
ty Experimental Rural Health Program in
which four county dentists participated. The
dentists expressed themselves as satisfied with
the latitude given them in conducting their
part of the program. The sponsors encourage
necessary changes as experience and conditions
indicate. The program has served more than
one-half the population of the county, and
the teeth of the children are greatly im-
proved thereby.
* * * *
Miscellaneous News Notes
There have been several distinguished visit-
ors to observe the state’s public health pro-
gram recently, among them, Dr. Yang-Shu-
hsin, a physician from China, one time division
chief of the Nanking Municipal Health Station
and health commissioner of Kansu Province.
At present he is a special member of the Na-
tional Health Administration, and during his
stay in Mississippi, he is giving attention to
the study of local and state health department
practices.
Visiting Mississippi to observe the maternal
and child health program carried on by the
State Board of Health are two prominent pub-
lic health figures from South America, Dr.
Jaime Ramirez of Sucre, Bolivia, and Dr.
Manuel Salcedo of Lima, Peru. Dr. Salcedo is
the able director of the National Service for
Protection of Mothers and Children in the
Ministry of Health and Social Assistance in
Peru. His excellent training and progressive
leadership lead to his being chosen as one of
the child health experts to consult with the
International Labor Office at its conference in
recent session in Montreal.
The chief medical officer of the maternity
and child health center at Chengtu, China, Dr.
Mei-yu Cheng, is scheduled to visit Mississippi
in the fall to study its public health program,
particularly maternal and child health.
Mrs. I. B. Trapp of Brandon, Dr. and Mrs.
T. B. Holloman of Florence, and Dr. and Mrs.
Gilruth Darrington of Yazoo City.
Womans J~luxiliary
President Mrs. L. J. Clark
Vicksburg
President-Elect Mrs. Stanley Hill
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson . .
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
CENTRAL AUXILIARY ENTERTAINS
DOCTORS
Members of the Woman’s Auxiliary to the
Central Medical Society honored their husbands
with the annual Doctor’s Day party last Fri-
day evening in the home of Col. and Mrs.
Lawrence Long on Peachtree Street.
The entertainment this year, given by the
members “as a gesture of appreciation to the
doctors,’’ was in the form of a buffet supper.
Many lovely spring flowers were used through-
out the home.
Receiving informally with Colonel and Mrs.
Long were Dr. and Mrs. W. R. Bethea. Mrs.
Bethea is president of the Auxiliary.
Mrs. A. G. Wilde served as general chairman
of arrangements for the party, with Mrs. Har-
vey Garrison in charge of decorations. Others
assisting were Mrs. J. A. Milne, Mrs. I. C.
Huggins and Mrs. J. Walton Lipscomb.
Those present were: Colonel and Mrs. Long,
Dr. and Mrs. W. R. Bethea, Dr. and Mrs. W.
C. Thompson, Dr. and Mrs. H. C. Sheffield,
Dr. and Mrs. A. G. Wilde, Dr. and Mrs. Robert
Price, Dr. and Mrs. H. C. Ricks, Dr. and Mrs.
George Owen, Dr. and Mrs. H. F. Garrison,
Dr. and Mrs. J. Walton Lipscomb, Col. and
Mrs. Daniel Campbell, Dr. and Mrs. J. T.
Weeks, Dr. and Mrs. John Harter of Sanator-
ium, Dr. and Mrs. Percy Wall, Dr. and Mrs.
Temple Ainsworth, Dr. and Mrs. John A. Milne,
Dr. and Mrs. Peyton Greaves, Dr. and Mrs.
I. C. Huggins, Captain and Mrs. Guilbeau of
the Jackson Army Air Base, Dr. and Mrs. Felix
Underwood, Mrs. Fred Hollowell of Yazoo
City, Dr. and Mrs. Temple Moore, Dr. and
DR. F. G. RILEY’S HOSPITAL & CLINIC
21st Ave., and 11th St.
F. G. Riley, M.D., F.A.A.P.
Practice limited to Pediatrics
R. L. Rhymes, B.S., M.D., F.A.C.S.
General medicine and surgery, especially Pediatric
Surgery
Meridian, Mississippi
HOWARD MAHORNER, M.D.
927 Canal Bldg.
New Orleans, Louisiana
—SURGERY-
PHYSICIAN WANTED: Physician for indus-
trial dispensary in South. Must be graduate
Class A school. Please write details and give
references in first letter. Expenses of inter-
view will be arranged for satisfactory appli-
cants. Write to Medical Director, Box 590,
Knoxville 5, Tennessee.
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MINUTE
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making much of your work easier and better?
In the home or in the hospital, you’ll always
find me on the job. I’m glad to have a part
in promoting good health, and believe you’ll
agree that I am the most economical assist-
ant you have. And the best part of it all is —
we both give good service under the free enter-
prise system!
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REDDY KILOWATT
Mississippi Power & Light
Company
Helping Build Mississippi
The Mississippi Doctor July, 1945
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Marion Sims and Other Nineteenth Century Pioneers:
the Dawn of Scientific Medicine and Surgery
SEALE HARRIS, M.D.
Birmingham, Alabama
PART 1
One hundred years ago in the then
small city of Montgomery, Alabama, Dr.
James Marion Sims was performing mir-
acles with scalpels, scissors, needles, silk and
silver wire sutures. Practicing surgical clean-
liness, his methods approached the aseptic
technique of the present time. He invented in-
struments that revolutionized surgery. He de-
vised and perfected operations that cured wo-
men of the accidents of childbirth from which
they had suffered, without relief, since Eve
ate the forbidden fruit in the Garden of Eden.
James Marion Sims
(1813-1883)
Sims was the pioneer in scientific surgery
of Alabama. Seeking a larger field of useful-
ness, he moved to New York in 1853, where be-
cause of professional jealousy, he was denied
the privilege of operating in hospitals. Without
friends, money or prestige, he founded the
Woman’s Hospital; and soon his operating
room v/as the mecca for medical students and
physicians in the great metropolis. He towered
above his adversaries as Saul did above Israel,
and after one year of practice in New York,
he ranked as the greatest American surgeon.
Then on to Paris in 1861 where he practiced
surgery for ten years, having among his pa-
tients Empress Eugenie. While treating her,
he lived in Saint Cloud, the summer palace of
Napoleon III. He performed operations suc-
cessfully which startled and delighted French
physicians; and in less than one year after he
arrived in Paris, he became the foremost sur-
geon on the continent of Europe. In 1870 he
volunteered for service and was commission-
ed a colonel in the French Army in the Franco-
Prussian War.
As surgeon-in-chief of a French army hos-
pital at Sedan, his technique in gunshot wounds
of the abdomen differed but little from that
by American surgeons in World War I and
World War II.
Back to New York in 1872, with the prestige
of unprecedented success in Paris, he again as-
sumed leadership in surgery in the medical
center of the United States. Though his envious
colleagues tried to destroy him the second
time, he was accorded every honor in the gift
of the medical profession in his homeland. For
the last ten years of his life, James Marion
Sims was revered as the greatest surgeon in
the world. On November 12, 1883, at the age
of seventy, he spent a busy day in his opera-
ting room. Included in his operations was a
difficult and successful surgical procedure on
the wife of a prominent New Yorker. After
dinner with his family Sims said: “This has
been one of the happiest days of my life.” That
night about eleven o’clock when he returned
from a visit to the hospital he complained of
a slight chill. Four hours later, he awakened
startled, called Theresa, his adored, talented
and beautiful wife, who had been comrade,
inspiration and full partner throughout his
professional career, — and without a struggle
388
Marion Sims — Harris
August, 1945
died in her arms. The ancient Greeks believed
that sudden death is reserved for the favorites
of the gods.
For drama, romance and achievement, the
meteoric career of James Marion Sims is
without parallel in the annals of medicine.
James Marion Sims was born January 25,
1813. He died on November 13, 1883. He was
one of a few pioneer doctors, who, in three
or four decades of the 19th century added more
to the basic knowledge of medicine and sur-
gery then had been accumulated in the thous-
ands of years that had passed since man was
known to inhabit the earth. Measured in terms
of lives saved, the sum of the achievements of
a dozen men, contemporaries of Sims,
has been the greatest boon to the human race
in the history of mankind. Untold millions
of men, women and children now living, and
yet unborn, will enjoy health and happiness
throughout long, useful lives because a few
geniuses had the vision to interpret correct-
ly phenomena related to various diseases, and
dared to achieve seemingly impossible tasks.
They were the medical master builders, who
drew the plans, laid the foundations, built the
frame work and placed the keystone in posi-
tion of the structure upon which modern medi-
cine and surgery have been built — but the
building is far from being ready for the cap-
stone. Medicine is yet a long way from being
an exact science.
Medicine as Practiced in the First Half of
the nineteenth century when bleeding, blister-
the history of medicine were in the first half of
the Nineteenth century when bleeding, blister-
ing, puking and purging were practiced. The
armamentarium of a doctor of that time con-
sisted of a lancet for venesection and opening
abscesses; cantharides for blisters — and as an
aphrodisiac ( ?) ; ipecac, squills, antimony, (tar-
tar emetic), stramonium, mercury, digitalis,
opium and a few other drugs — all of which were
used empirically.
Malaria: While cinchona bark had been in-
troduced into Europe in the seventeenth cen-
tury, its alkaloid, quinine sulphate, was not iso-
lated until the early part of the nineteenth
century. Quinine was not in general use in the
United States until after 1850. Hundreds of
thousands of citizens of the new republic died
of malaria in the first half of the nineteenth
century. Sims said of the treatment of malaria
before quinine was available: “Patients were
bled, purged, administered tartar emetic, and
given fever mixtures every two hours day and
night; they were salivated, and they died. Those
who were bled and purged the strongest died
the quickest.”
A few years later when quinine came into
general use in Massachusetts, Oliver Wendell
Holmes, contemporary with Sims, in pictur-
esque language cried out against the heroic
treatment of malaria then generally practiced.
He said: “What wonder that the stars and
stripes wave over doses of ninety grains of
quinine and that the American eagle screams
with delight to see three drachms (180 grains)
of calomel given at a single mouthful.”
An epidemic of malignant malaria, described
by Sims, probably caused the deaths of at
least half the settlers in, and near, Mount
Meigs, Alabama, in the summer and fall of
1835. After having witnessed the deaths of
many of his friends and patients from malaria,
Sims himself contracted the disease and went
to bed, expecting to die. He refused to be bled,
puked and purged. Plis life, therefore, was pro-
longed for a few days, when a druggist from
Montgomery, who had a few doses of quinine in
his satchel, chanced to be in Mount Meigs. He
gave his quinine to a doctor whom he had
never seen before, and thus saved the life of
a man who later made discoveries that brought
health and happiness to millions of others.
Sims was “snatched from the grave” the
second time in 1840, when Dr. Holt of Mont-
gomery brought quinine to him at Shorters,
Alabama, where he had another attack of
malignant malaria.
Smallpox. In the eighteenth century small-
pox prevailed all over the world, even in re-
mote islands. George Washington developed
smallpox in 1751 at Bridgeport on the little is-
land of Barbados in the West Indies, whence he
had carried the half-brother, Lawrence, in quest
of a cure for tuberculosis. He said in his diary
that he “was strongly attacked with small-
pox”. Rupert Hughes, in his biography of
Washington said: “When one imagines what
a difference it meant to the world whether or
not the young Virginian, gasping in the remote
little island, should join the throng graveward,
or should recover, the name of Dr. Landham
[the doctor who treated Washington], should
not be forgotten. Washington survived and the
immunity to further attacks of smallpox was
of infinite value to him all his life. But his
Marion Sim® — Harris
389
August, 1945
face was thereafter pitted, as at least one-
third of the faces in antivaccination days ;
yet, Weems, who knew him, assures us that
the smallpox ‘marked him rather agreeable
than otherwise’.
Smallpox was prevalent in some of the sparse-
ly settled American colonies at the outbreak
of the Revolutionary War. When the Colonial
Army collected many men together it became
a scourge among the soldiers of both the
American and British armies, particularly in
prison camps. Of 20,000 American slaves, cap-
tured by the British and who were kept in
concentration camps, it is estimated that 15,-
000 died of smallpox. During the Revolution-
ary War an epidemic of smallpox in South
Carolina caused the deaths of more soldiers
in that state than were killed by the British
Army.
Lord Cornwallis’ troops overran Lancaster
County, South Carolina — in which twenty-
five years later Marion Sims was born — and
captured many colonial soldiers, some from the
army of the intrepid General Francis Marion,
“the iSwamp Fox” of Revolutionary fame — for
whom Marion Sims was named. These captured
soldiers, and many civilians, revolutionary
sympathizers, were sent to a British prison
camp in Columbia, South Carolina. Included a-
mong them were neighbors and relatives of
the Jackson family in the Warsaw settlement,
then the headquarters of General Cornwallis.
The mother of President Andrew Jackson, who
at that time was a boy fourteen years of age,
though she knew that it meant almost certain
death, volunteered to serve as a nurse to aid
in caring for colonial soldiers stricken with
smallpox in the British prison camp at Colum-
bia. Sarah Jackson contracted smallpox and
died. She was one of the casualties, and a
heroine, of the fight for freedom by liberty-
loving Americans. This episode is mentioned
because it brings out something of the back-
ground of Marion Sims. The Jacksons were
distant neighbors of Sims’ grandfather and
grandmother.
Edward Jenner. One bright spot on the hori-
zon before the dawn of scientific medicine was
the discovery by Edward Jenner (1749-1823)
that the inoculation of humans with the virus
of cowpox would prevent smallpox. Jenner’s
announcement of his great discovery, in 1798,
came too late to save many thousand early
Americans, and it came after smallpox had
destroyed at least one-fourth . the population
of the British Isles and the continent of
Europe; but vaccination was generally practic-
ed in the United States in the early years of
the nineteenth century.
Marion Sims was ten years old when Edward
Jenner died in 1823. Jenner left vaccination as
a legacy to billions of human beings who would
live after him. Marion Sims was one of his
legatees. Vaccination probably saved his life
when he, then a medical student in Philadel-
phia in 1826, nursed a fellow-student, day and
night, for a week before he died of a virulent
form of smallpox. It is not possible to estimate
how many men and women who have made
great discoveries, have been saved to civiliza-
tion because a country doctor in England inter-
preted the phenomenon of immunity to small-
pox among dairy-maids, to mean that the in-
oculation of human beings with the virus of
vaccinia (cowpox) would render them immune
to variola (smallpox).
Deadly Surgery. When Marion Sims was
graduated from Jefferson Medical College in
Philadelphia in 1836 the surgery then practiced
was crude and murderous, though only minor
operations were attempted. The lancet, a small,
very sharp, double-edged, folding knife, kept in
the doctor’s vest pocket when not in use, was
probably the deadliest instrument ever de-
vised by man. From the first day it was used
by a doctor to open an abscess, it carried
pyogenic bacteria to infect the wounds in-
flicted by him on his trusting patients, until
palsy, or death, came to end the career of its
well-meaning owner.
Next to the surgical instruments used by
physicians from 1800 to 1865, the doctors
themselves transmitted deadly germs from one
patient to another, on their hands and clothes.
It is probable that in the dark days of the
first half of the nineteenth century doctors
killed more of their patients than they cured.
Physicians of that period were as able and as
conscientious practitioners as they are of this
day of scientific medicine and surgery. They
applied the medical knowledge then available
to them, and they are not to be blamed for the
tragedies of the sick room that occurred in
that black era of medicine. They did their
best — “and an angel could do no more.”
But there lived in the first half of the nine-
teenth century many doctors who realized the
menace to their patients resulting from the
medical and surgical treatment of the sick as
390
Marion Sims — Harris
August, 1945
then practiced. They were dissatisfied with
themselves and disgusted with medicine and
surgery; they began to doubt the teachings of
the so-called authorities who wrote the text-
books and to think for themselves.
Ephraim McDowell. No surgeon had dared
to invade “the sacred precincts” of the ab-
domen until Ephriam McDowell (1771-1830),
pioneer doctor, removed an abdominal tumor
weighing 22 pounds from Jane Todd Crawford,
in his own home at Danville, Kentucky, in 1809.
While he was operating, a number of protesting
neighbors waited outside his house to hang
McDowell had Mrs. Crawford died from the un-
heard of procedure. Fortunately she lived. Dr-
McDowell found his (now famous) patient up
making her bed on the fifth postoperative day.
She went home, sixty miles, on horseback on
the twenty-fifth day. She lived to be seventy-
nine years of age.
McDowell waited seven years, until he could
add two other successful cases, before he pub-
lished a report of his operation in the Eclectic
Repertory in 1817. An envious and jealous doc-
tor published an article later in the same jour-
nal in which he expressed doubts of McDowell’s
veracity. McDowell’s reply, published in 1819, in
which he added reports of two other successful
cases, was convincing; but during his lifetime,
“the father of abdominal surgery” received no
credit from American and British surgeons
for his great achievement. Half a dozen sur-
geons attempted the operation, but most of
their patients died of general peritonitis. In
1841 the Atlee Brothers of Lancaster, Pennsyl-
vania, operated successfully on a woman who
had an abdominal tumor, and they gave full
credit to Ephraim McDowell for his pioneer
surgery of the abdomen.
McDowell’s operation was attempted by John
Lizars in Edinburgh in 1823 but he failed to
find a tumor. In publishing a report of his case,
Lizars included a review of McDowell’s cases.
In 1829, a year before his death, McDowell
had a record of eleven operations for ovarian
tumors with only one death. Had he been op-
erating in a city hospital, in which at that time
infections almost invariably followed every
kind of surgical procedure, his operative mor-
tality probably would have been a hundred
per cent.
In 1842, eleven years after Ephraim Mc-
Dowell’s death, and thirty-three years after
his first ovariotomy, Charles Clay of Man-
t
Chester, England, successfully removed an
ovarian tumor. To the British he is “the father
of abdominal surgery” — even though the facts
of McDowell’s successful operations three
decades before were submitted to English
gynecologists.
The Discovery of Anesthesia. The progress
of surgery had been stifled for centuries be-
cause the torture of the victim of any kind
of an operation made it impossible to attempt
anything but emergency surgery. The dis-
covery of anesthesia therefore was the first
step in the development of modern surgery.
The first physician to perform a surgical
operation in which the patient suffered no
pain was Dr. Crawford W. Long (1815-1878),
who lived in the village of Donaldsville, near
Athens, Georgia, in 1842. To amuse his friends,
Dr. Long gave what he called “ether frolics”
in his office. On such occasions after inhaling
a few whiffs of sulphuric ether, the young
folk became acutely intoxicated. They would
fall over chairs and do many queer, laughable
things. Sometimes they sustained large bruises
when they were under the influence of ether.
After recovering consciousness they did not re-
member feeling any pain from such injuries.
It occurred to Dr. Long that surgical opera-
tions could be performed without pain if the
patient were etherized. His first operation
on a patient under the influence of ether was
the removal of a tumor from the neck of
James Venable in 1842. During the same year
he performed several other operations with the
patients under the influence of ether.
Unfortunately Dr. Long did not publish a
report of his cases until after Dr. Horace
Wells 1815-1848), a dentist of Hartford, Con-
necticut, had used nitrous oxide to prevent
pain in the removal of a tooth in 1844; and
William Morton (1819-1868) had used ether
in an operation performed by Dr. Warren,
senior surgeon of the Massachusetts General
Hospital in Boston, in 1846, Had Dr. Long re-
ported his operations on etherized patients
he would have had the indisputable credit for
the discovery of surgical anesthesia; and he
would have prevented one of the most discredit-
able controversies in the history of medicine.
The facts of this controversy were as follows:
William Morton was a student of dentistry
under Dr. Horace Wells when the latter first
used nitrous oxide gas for the painless removal
of a tooth. Later at Harvard,- where he was
studying medicine, Morton learned from Dr.
391
Marion Simis — Harris
August, 1945
Charles Thomas Jackson (1805-1880) that sul-
phuric ether had properties similar to nitrous
oxide — Jackson also claimed to have suggested
to Morse the principle of the telegraph.
After the widely publicized operation under
ether at the Massachusetts General Hospital,
Morton applied for a patent on the well-known
drug, ether, under the trade name of “letheon.”
He then announced to dentists and doctors: “I
am now fully prepared to dispose of licenses
to use my invention and apparatus in any part
of the country upon the following general
terms :
“TERMS FOR DENTISTS (five years)
In cities of 150,000 inhabitants, $200;
In cities of 50,000, and less than 150,000 ;$150;
In cities of 40,000, and less than 50,000, $100 ;
In cities of 30,000, and less than 40,000, $87;
In cities of 20,000, and less than 30,000, $75;
In cities of 10,000, and less than 20,000, $62;
In cities of 5,000, and less than 10,000, $50.
“Surgeons’ licenses for five years, 25 per
cent, on all charges made for performing
operations wherein the discovery is used, etc.,
etc.
“W. T. G. Morton"’
Wells accused Morton of “stealing” his dis-
covery of anesthesia. Morton and Jackson had
a quarrel in their effort to commercialize ether
and dissolved partnership. Jackson claimed
that he had “invented” anesthesia — that he
had given the idea to Morton was not denied.
He then joined Wells in the effort to discredit
Morton. Morton failed to get a patent on “le-
theon” and applied to Congress for an appro-
priation of $100,000.00 for the privilege of
using ether in the United States Army and
Navy. In the meantime the controversy raged
among the doctors of Boston and unethical
conduct was charged against Morton. Morton
and Jackson presented their claims to priority
of the discovery of anesthesia to a Congress-
ional committee. The acrimonious and vitupera-
tive testimony to discredit Morton covered
fifty-seven pages of the Congressional Record.
The tricomered fight raged in Congress until
a senator from Georgia presented proof that
Crawford W. Long had used ether in operations
two years before Wells had used nitrous ox-
ide, and four years before Morton had used
ether. Whereupon a disgusted Congress killed
the bill to reward William Morton for the dis-
covery of anesthesia.
Oliver Wendell Holmes (1809-1894) coined
the noun “anesthetic” 'to define the substance
used in producing wHat he called “anesthesia.’
During the controversy which raged between
Morton and Jackson, Holmes, when asked to
whom should be given the credit for discover-
ing anesthesia, replied: “To e(i)ther.”
The lives of Wells and Morton became em-
bittered, and their usefulness was largely
destroyed, because of their hatred for each
other, and their eagerness for fame. Wells in
an attempt to produce surgical anesthesia with
nitrous oxide caused the death of a patient
on the operating table. A few years later he
ended his unhappy life by severing his radial
artery. Morton neglected his practice and be-
came poverty-stricken to the extent that his
friends had to aid in the support of his fami-
ly. Disappointed and miserable he died of apo-
plexy at the age of fifty-one.
A statue of Crawford W. Long stands in the
Congressional Hall of Fame, in Washington,
presented by his native state of Georgia; and
his Alma Mater, the University of Pennsyl-
vania, had a tablet placed in one of the build-
ings, commemorating him as “the discoverer of
anesthesia.” In Hartford, Connecticut, there
is carved on the granite pedestal of a statue,
the name of Horace Wells, “the discoverer of
anesthesia.” In the Massachusetts General
Hospital in Boston there is a tablet in memory
of William Morton, “discoverer of anesthesia.”
In Germany there is, or was in 1906, a statue
erected to proclaim to the world the name of
the German “discoverer of anesthesia.”
Who discovered surgical anesthesia is of less
importance that the fact that it was discovered.
It has revolutionized the practice of surgery,
and has alleviated the sufferings of untold
millions, many of whom without it, would have
been denied life-saving surgical operations.
Chloroform. Morton deserves credit for be-
ing the first to report a successful operation
under the influence of ether. The news traveled
fast around the world with far-reaching ef-
fects. In less than a year later, in 1847, Sir
James Simpson (1811-1870), professor of medi-
cine and obstetrics in the University of Edin-
burgh, tried ether to deaden the painsi pf
childbirth. The odor of the ether and the first
stage of intoxication was so disagreeable to the
patient that she could not be completely anes-
thetized. Simpson, one of the great medical
pioneers of his time, discovered that chloroform
was pleasant to take, and that its effects were
392
August, 1945
Marion Sims — Harris
quicker and more profound than ether. Simpson
used chloroform in a difficult case of labor
with such happy results that he published
a report of this case a few weeks later. His
discovery brought the denunciation of the
clergy on his head for interfering with God’s
edict (?) that “in sorrow thou shalt bring
forth children.’’ But Simpson’s head was not
defenseless. His replies to the clerics, and to
Dr. Meigs of Philadelphia, and other conserva-
tive doctors who joined in the wordy opposition
to the use of chloroform in labor, silenced
them and other critics. In less than two years
chloroform had been used on 50,000 persons
in Edinburgh alone. Howard W. Haggard, au-
thor of Devils, Drugs and Doctors , in des-
cribing the controversy over the use of chloro-
form in childbirth gave to medical literature
one of its most dramatic chapters.
But Simpson’s discovery of chloroform anes-
thesia was not altogether a benevolent ac-
complishment. While it may be a comparatively
safe anesthetic for women in parturition, since
few fatalities have been reported from its
use, it has caused more tragedies in the operat-
ing room than all the other anesthetics com-
bined.
Dr. Sims was one of the first to call at-
tention to the high mortality from the use
of chloroform, which even in the United States
where the use of ether as an anesthetic was
discovered, because of the ease of the ad-
ministration, was widely employed in surgery.
In Europe chloroform was used almost al-
together. Dr. Sims in his autobiography gave
a dramatic account of a near fatality from
chloroform in an operation which he per-
formed in Paris in 1861, for vesico-vaginal fis-
tula on a very rich and important patient of
Nelaton, the then premier surgeon of France.
Fortunately for Sims the patient survived ;
the operation was completed, and the woman
cured. In discussing this case Sims said:
“Deaths from it (chloroform) in general sur-
gery occur constantly, and for unimportant
operations.” He concluded: “I think the safest
plan is to relinquish the use of chloroform al-
together except in obstetrics. The frequent
cases of death from the use of chloroform in
surgical operations that have occurred among
us should warn us to give up this dangerous
agency, if we can find another that is efficient
and at the same time free from danger. Ether
fulfills this requisite to a remarkable degree;
but while it is safe, it is offensive to the
physician and bystanders as well as to the
patient. Chloroform is delicious and danger-
ous; ether is disagreeable and safe in purely
surgical cases.”
Sims protested against the use of chloro-
form for thirty years before his death in
1883, and he endeavored to find a substitute
for chloroform and ether. He tried nitrous
oxide in 1868 — and published an article in the
British Medical Journal, setting forth the ad-
vantages and the imperfections of the anes-
thetic discovered by Wells in 1844. In 1874
he read a paper before the British Medical
Association, published also in the American
Journal of Medical Sciences, in which he called
attention to the hazards of chloroform anes-
thesia, but described Nelaton’s method of re-
suscitation in the event of threatened danger
during its administration.
iSims had never heard of Dr. Crawford W.
Long until in October 1876, when Dr. P. A.
Wilhite of Anderson, South Carolina, informed
him that in 1842, when Dr. Crawford W. Long
was his preceptor in the study of medicine,
he had assisted him in the first operation ever
performed under the influence of ether. Dr.
Wilhite also said that he had administered
ether to several patients operated upon by
Dr. Long in 1842, 1843 and 1844. On further
investigation Sims became convinced that
credit for the discovery of ether as a surgical
anesthetic should be given to Dr. Long. In
1877 he prepared an article in which he listed
Long as the discoverer of ether in 1842, and
Horace Wells as the discoverer of nitrous ox-
ide anesthesia in 1844. He felt that Morton
should be credited with having brought the
attention of the medical profession to ether
as a surgical anesthetic. He personally raised
a considerable sum of money from among his
surgical friends and sent it to Dr. Long, then
an old man living in Athens, Georgia, as an
expression of appreciation for his discovery of
ether as an anesthetic. Crawford W. Long died
in 1878. The following year Sims published an
article on “History of the Discovery of Ether,”
in which he insisted that Long was the dis-
coverer of surgical anesthesia.
Sims continued the search for a safe anes-
thetic without the disagreeable effects of ether.
He was induced to try bromide of ethyl. The
patient died a few days later from acute
nephritis, which Sims thought was induced by
the use of bromide of ethyl. He reported the
August, 1945
Marion Sims — Harris
393
case at a meeting of the New York Academy
of Medicine in 1880. The paper was published
in the Medical Record and Gaillard’s Monthly.
In spite of the crusade by Sims against the
use of chloroform in surgical anesthesia it
was in general use in the United States until
the first decade of the twentieth century, and
even now it is preferred by a few surgeons of
limited experience. It may not be inappropriate
to mention that in 1901, my son, then an in-
fant, eighteen months old, was almost killed
by a hospital interne, who was not aware of
the danger from chloroform. Dr. Bodine in the
Polyclinic Hospital — founded by Sims’ son-in-
law, Dr. James A. Wyeth — was performing a
simple circumcision. I saw that the child was
getting too much chloroform but the interne
poured more on the inhaler. I caught his arm
and prevented him from placing it on the
child’s face. At that moment Dr. Bodine saw
that the child had stopped breathing and was
deeply cyanotic. He saved his life by catching
him by the feet and hanging his head down
while artificial respiration was performed — the
Nelaton method which Sims brought back from
Paris. In a few minutes the child was breathing
again and the operation was completed.
Even after that near tragedy I preferred
chloroform as an anesthetic, believing that the
accidents resulted from its improper adminis-
tration. My associate, using the drop method,
could keep an adult anesthetized for two hours
with less than two drachms of chloroform.
In 1904 a strong husky man, thirty years of
age, walked from his home to the hospital for
an elective minor operation. After inhaling a
few drops of chloroform he became livid and
stopped breathing. In spite of prolonged efforts
at resuscitation he never breathed again. He
evidently died instantly of heart failure. This
tragedy incited me to investigate the mortality
of chloroform anesthesia in Alabama. Question-
naires sent to a large number of physicians
revealed that at least one person out of a
hundred on whom chloroform had been used
by capable Alabama physicians, died — usually
after inhaling a few drops of chloroform. So
many doctors in Alabama had had deaths from
chloroform, they abandoned its use. Chloro-
form was the anesthesia of choice in Europe
as late as 1906. The United States Government
prohibited the manufacture of heroin years
ago because it was a dangerous habit-forming
narcotic. Many lives could be saved if chloro-
form could be thrown in the waste basket of
drugs that have been tried and found too
dangerous for use in medicine and surgery.
Oliver Wendell Holmes. Another of the
pioneers searching for light and not afraid
to tell the truth, was Oliver Wendell Holmes,
who was born in Boston in 1809, four years
before the birth of James Marion Sims. Holmes’
great contribution to medicine was in 1843
when he proved that childbed fever is a con-
tagions disease, and that it is transmitted
from patients with puerperal fever, erysipelas
and infected wounds, to women in labor
through the medium of the hands and clothes
of doctors and midwives. That was two decades
before the Hungarian-born Ludwig Semmel-
weis (1818-1865) began to investigate the ap-
palling conditions in the obstetrical wards of
Vienna hospitals and to search for causes of
the frightful death rate among women con-
fined in them. It was more than a quarter of a
century after Holmes’ paper on puerperal fe-
ver was published before Pasteur proved his
germ theory of disease.
Holmes reported a number of small epidemics
of ‘childbed fever” in the practice of individual
doctors. He admitted his belief that he, him-
self, had been responsible for the death of
women whom he had delivered. He advocated
thorough cleansing of the hands and a change
of clothes before attending any woman in la-
bor; and asserted, with emphasis, that a phy-
sician who was treating a case of childbed fe-
ver, erysipelas or an open wound should not
be permitted to attend a woman in labor.
Holmes’ paper made but little impression
on the medical profession generally ; but it
brought forth the condemnation of the ob-
structionists to medical progress, particularly
Dr. Charles Meigs, professor of obstetrics in
the University of Pennsylvania. Meigs con-
demned Holmes’ article as a reflection on the
cleanliness and integrity of doctors, and he
ridiculed his theory in general. Holmes’ reply,
characteristically rhetorical, scintillated with
satire. Apparently the controversy between
Holmes and Meigs created a sensation in medi-
cal circles at the time; but the reforms ad-
vocated by Holmes intended to reduce the
number of deaths from puerperal fever were
not taken seriously by the American physicians
and his methods were not carried out, except
by the friends and admirers of the Bostonian
doctor.
394
Marion Simis — Harris
August, 1946
Ludwig Semmelweis. Apparently Holmes’
theory of the contagiousness of puerperal fever
was unknown to European doctors when Lud-
wig Semmelweis, in Vienna, in 1847-1849, at-
tacked the “childbed fever” problem from a
different approach. He proved that medical
students, who worked in dissecting halls be-
fore attending charity cases of obstetrics, were
largely responsible for the high mortality in the
lying-in wards of hospitals connected with the
University of Vienna. Semmelweis also proved
that the dirty linen and filth in hospital wards
were a factor in disseminating puerperal fever.
He was demoted because the reforms he ad-
vocated would cut off petty graft in the hos-
pital laundry; but not until he had called at-
tention to the fact that in the wards in which
medical students worked there were from 68
to 158 deaths in each 1000 births, while an-
other ward in which the women were delivered
by midwives the mortality rate was 33 deaths
in 1000 births. The great Viennese doctor
finally concluded that puerperal fever in Vien-
na hospitals was due to blood poisoning, trans-
mitted by the unclean hands of medical stu-
dents, midwives, and doctors, and by the use
of dirty linens, and the generally filthy con-
ditions in the lying-in wards of the hospitals.
Semmelweis, like every other man who has
brought about benevolent reforms, was per-
secuted for being a progressive. His envious
and jealous confreres made every possible ef-
fort to destroy him, but he succeeded in having
the obstetrical wards renovated. He saw to it
that they were supplied with clean bed-linen;
that women were required to bathe, and they
were provided with a freshly laundered gown
at the beginning of labor. He instructed medical
students not to go from dissecting rooms to the
obstetrical wards of the hospital without a
complete change of clothes; and he required
each student to wash his hands thoroughly
with soap and water and then in a solution
of chloride of lime before making examina-
tion of women in labor.
At the time Semmelweis began his reforms,
approximately one out of every eight women
who were delivered of babies in the Vienna
hospitals, died of puerperal fever. In seven
months the number of deaths in the same
obstetrical wards dropped to one in eighty-five
women delivered. In one hospital division there
was not a single death from puerperal infection
in two months. In spite of his triumph in saving
the lives of parturient women, Semmelweis
tired of the struggle, and disgusted with the
tactics of his confreres, left Vienna and re-
turned to his native city, Budapest, in 1855.
There he wrote a book, The Aetiology , Con-
cept, and Prophylaxis of Childbirth Fever,
which gave to the world methods of preventing
puerperal fever — essentially asepsis in the man-
agement of labor — that revolutionized the prac-
tice of obstetrics and has saved the lives of
millions of mothers. Semmelweis died at the
age of forty-seven, from septicaemia, resulting
from an infected finger — the disease which he
sought to prevent in mothers as they brought
their children into the world. Semmelweis’ life
was turbulent and unhappy. He died without
realizing that he had achieved more for the
good of mankind than all of the kings, queens
and emperors of Austria and Hungary. His
name will be revered when Maria Theresa,
Francis Joseph and all the other rulers of the
House of Hapsburg have been forgotten.
Sims, the Father of Gynecology. Marion
Sims’ greatest achievement, though not his
only important contribution to scientific sur-
gery, was in devising an operation for vesico-
vaginal fistula, then considered an incurable
condition. The scientific management of dis-
eases of women had its origin in Montgomery,
Alabama, when the Sims’ speculum was in-
vented. It gave the surgeon perfect visualiza-
tion of the vesico-vaginal and recto-vaginal sep-
ta, and the cervix of the uterus. Without this
discovery the accurate diagnosis and adequate
treatment of diseases of women could not have
been possible.
Sims’ simple story of the incidents that led
up to his undertaking and operation for vesico-
vaginal fistula, the delineation of his failure for
four years, and the final success of his efforts
to relieve this hitherto hopeless condition, make
one of the most thrilling chapters in medical
literature. It was an accident that Sims, in the
course of six weeks, was called upon to treat
three cases of vesicovaginal fistula in slaves,
who because of their disability were hopeless
invalids and valueless to their owners; but
the perfection of the operation was the result
of definite ideas of the problems involved in
devising a cure for vesicovaginal fistula, com-
bined with infinite patience, courage and per-
severance.
The success of Sims’ operation for vesico-
vaginal fistula depended upon his ingenuity
in devising a number of instruments and in
perfecting procedures in vaginal surgery that
August, 1945
Marion Sinus — Harris
395
never before had been achieved. The first step
followed the accidental discovery in the exami-
nation of a woman who had been thrown from
a horse, that atmospheric pressure will balloon
the vagina, so that the vesicovaginal septum
may be clearly visible for operation. Sims first
used the handle of a pewter spoon to open the
vagina to atmospheric pressure, and to hold
it open, and then he invented his speculum,
which has not been improved up to this time.
He then devised a retention catheter to drain
the bladder and prevent its distention by urine.
The third step was to use the silver wire su-
ture, instead of silk; and the fourth was the
use of perforated shot to hold the sutures in
place.
It required several failures in operating upon
Anarcha, Betsy and Lucy, before improved
methods had corrected the faults in technic of
former operations; but Sims did not despair
as did his associates and some of his relatives,
who begged him to devote himself to patients
who could pay instead of breaking down his
health from overwork in quest of the impos-
sible. But genius is not easily discouraged and
Sims continued until May, 1849, when with
“palpitating heart and anxious mind” he found
that he had cured Anarcha — the first time in
the history of the world that an operation for
vesicovaginal fistula had been performed suc-
cessfully.
Sims’ exuberant gratification at his success
was pardonable. It was expressed as follows:
“In the course of two weeks more, Lucy and
Betsy were both cured by the same means,
without any sort of disturbance or discomfort.
Then I realized the fact that, at last, my efforts
had been blessed with success, and that I had
made, perhaps, one of the most important dis-
coveries of the age for the relief of suffering
humanity.”
Slave Heroines. It was fortunate for Sims
that his first three patients, Anarcha, Betsy
and Lucy, were Negro slaves, who by heredity
and environment made ideal subjects for ex-
perimental studies such as he carried out on
them for four long discouraging years. Sims
performed thirty operations without an anes-
thetic on Anarcha alone before she was cured.
Livingstone maintained that the Negroes in
their native Africa stood pain better and en-
dured punishment of all kinds with greater
fortitude than civilized people; and Rudolph
Matas, Hunter McGuire and other surgeons
have stated that the American Negroes are
stoics in standing pain and that they make
better surgical subjects than the whites. The
training as slaves made Anarcha, Betsy and
Lucy submit without question to the commands
from their masters to allow Dr. Sims to per-
form any necessary operations; and the hope
of relief from the dreadful conditions result-
ing from vesicovaginal fistulae, no doubt made
them willing subjects for experimentation.
Many Europeans berated and ridiculed Sims for
cruelty to helpless slaves.
Sims relates that Anarcha, Betsy and Lucy
had kind masters; and no doubt Sims treated
them with as much consideration as he did
his patients, the Duchess of Hamilton, the
Empress Eugenie of France and the Empress
of Austria. Sims maintained these three slaves
in his hospital and treated them for four years
without pay or hope of reward, other than the
satisfaction of curing the most dreadful con-
dition known to woman, and the hope that he
might find the way to relieve others. Sims
was discouraged but Anarcha cried and begged
him to “try, please try one more time!” Never
in history has there been another instance
of such devotion to duty and the cause of
science. Anarcha, Betsy and Lucy should be
immortalized as the first heroines in the story
of the development of modern gynecology ;
just as Jane Todd Crawford in the pioneer
days of Kentucky will be revered always in
the memory of men and women along with
Ephraim McDowell, the founder of abdominal
surgery.
Claude Bernard. When Marion Sims was in
Paris from 1861 to 1870, the French capital
was the medical center of the world. Among
the great Frenchmen of the time was Claude
Bernard, the aristocrat in medicine. He was
born in 1813, and therefore like Marion Sims,
was forty-eight years of age in 1861. Claude
Bernard was working in the most complete
physiological laboratory in the world at that
time, except perhaps that of Carl Fredrick
William Ludwig (1816-1895) of Leipzig, Ger-
many, whose vast studies on circulation sup-
plemented those of the great Harvey.
Claude Bernard accidentally found sugar in
the hepatic vein of a man, upon whom an
autopsy had been performed. This he inter-
preted as meaning that the liver produces,
stores and releases glycogen, which when car-
ried in the blood to every part of the body
and burned, produces heat and energy — and
he proved his premise. His studies on diabetes
396
Marion Sims — Harris
August, 1946
stimulated many other laboratory investiga-
tions to seek for the cause of that fatal dis-
ease. These studies culminated in Von Meh-
ring and Minkawski producing diabetes melli-
tus in dogs by removing the pancreas in 1888;
and the discovery of insulin by Frederick Grant
Banting, an obscure Canadian doctor, and his
co-worker, Charles Herbert Best, a sophomore
medical student, in the physiological labora-
tory of the University of Toronto in 1921. Thus
scientific medicine conquered a disease that
baffled physicians from the time when Aretae-
us, the Cappadocian, first described and named
diabetes mellitus in the second century of the
Christian era. Claude Bernard was the pioneer
in blood chemistry and in physiological investi-
gations in nutrition.
Virchow. Rudulf Virchow (1821-1902) was
the noblest German who has ever lived, and one
of the greatest men of all time. He accom-
plished more to develop the scientific diagnosis
of disease as now practiced than any other
of the great pioneers of his time. Before Vir-
chow was thirty-five years old he had com-
pleted microscopical studies on the tissue cells
of various organs that led to a comprehensive
knowledge of disease processes. He developed
methods of diagnosis which made the micro-
scope and laboratory indispensable in medical
and surgical practice. When his greatest work,
Die Cellular Pathologie, was published; in 1856,
it changed the physician’s concept of disorders
of the human body from guesswork to exact
knowledge of the marked changes that take
place in disease. Virchow lived to know that
laboratories, equipped to use his methods of
tissue diagnosis and study of disease, were
established in every large hospital in all the
civilized nations of the world.
The late Sir Frederick Banting, who achieved
fame in his brilliant researches that culminated
in the discovery of insulin, said that the Ger-
mans can be credited with few original ideas,
and that they discovered scarcely one basic
principle ; but they were masters in developing,
and improving upon, the ideas which they ap-
propriated from others. Virchow developed
cellular pathology into a science; but the idea
originated in the discovery by Robert Hooke,
in the seventeenth century, that plants are
made up of microscopic cells. In 1815 Robert
Brown, a botanist, discovered a nucleus in each
cell. Bichat, French anatomist, made the first
microscopic studies of animal tissue under the
microscope in the eighteenth century. He de-
scribed twenty-one distinct types of tissues, or
“membranes.” Bichat concluded that “disease
must ultimately be some change in one or more
kinds of tissue.”
Schleiden, of Hamburg, in 1838 confirmed
the work of Robert Brown and he expressed
the belief that the nucleus is essential for the
reproduction of like cells in plants. Theodor
Schwann extended the work of Schleiden and
proved that “all vegetable and animal tissues
are composed of and developed from cells.”
Hagensen ahd Lloyd, in A Hundred Years of
Medicine asserts that “it was Rudulf Virchow
the most influential of all Germany’s medical
thinkers, who applied the discoveries of Hooke,
Schleiden and Schwann to the intimate study
of disease.” Virchow must be credited with de-
veloping the science of pathology.
Virchow was a humanitarian, and therefore
did not please German officials, when in 1848
he was sent to Upper Silesia to investigate the
causes of an outbreak of relapsing fever. He
reported the miserable living conditions and
the semistarvation of the inhabitants in a Ger-
man province, and incurred the wrath of Prus-
sian overlords. As a result he was forced to
give up work in his Berlin laboratory. However,
he continued his studies as professor of path-
ology at Wurtzburg, where in 1856 he had
achieved such distinction that he was invited to
become professor of pathology in the Universi-
ty of Berlin.
In 1880 Virchow became a member of the
Reichstag, where he failed in combatting the
deadening Deutschland uber alles dream of
Bismark. Unfortunately for a potentially great
people the Germans followed the leadership
of the “Iron Chancellor” instead of adopting
the humanitarian principles advocated by Ru-
dulf Virchow. That mistake in following the
wrong leadership was the beginning of the end
of Germany as a great nation.
Pasteur. Measured in terms of lives saved
and in promoting health, happiness, efficiency,
prosperity and long life among civilized people,
Louis Pasteur (1822-1895), a French chemist,
was the greatest man who has lived. While not
a physician, he discovered that micro-organ-
isms (germs, microbes, bacteria and viruses)
cause disease of wine, silk worms, chicken
cholera, anthrax and hydrophobia (lockjaw).
In 1863 Pasteur said to Emperor Napoleon III
of France: “My ambition is to arrive at the
knowledge of putrid and contagious disease.”
His ambition was fulfilled; and the knowledge
August, 1945
Marion Sims — Harris
397
which Pasteur acquired, that no man had ever
dreamed of before, he applied in the prevention
of contagious diseases; first of wine, then of
silk worms, chicken cholera, anthrax in sheep,
and rabies in dogs and hydrophobia in man.
In the prevention of sepsis in wounds Joseph
Lister, in 1866, applied Pasteur’s proved theory
that micro-organisms in the air cause putre-
faction. Louis Pasteur was the founder of
scientific medicine and surgery; and the pre-
vention of all communicable diseases is based
upon the principles which he discovered. The
average length of life has been increased by
approximately thirty years — nearly doubled —
since the phophylaxis of diseases, medical and
surgical, based upon Pasteur’s germ theory,
and his principles of vaccination have been ap-
plied in all civilized countries.
Pasteur’s first great achievement was in
proving that micro-organisms in the air are
the cause of fermentation. He found that by
heating wine to near the boiling point and
keeping it in bottles from which air was ex-
cluded, further fermentation into vinegar would
be prevented. He proved that putrefaction
could be prevented by heating meat and meat
broths and keeping them in closed containers
from which air was excluded. He also proved
that the fermentation of milk and butter could
be prevented by the same process. This prin-
ciple— what is now known as pasteurization —
when applied saved the wine industry in France
from ruin. Applied to the prevention of diseases
which may be carried in milk in i.e., tubercu-
losis, typhoid fever, undulant fever, dysentery,
and other bacterial diseases, pasteurization has
been a large factor in reducing the general
death rates. The first ten years in which pas-
teurization of milk was required by law, in New
York City the death rates of children under
five years of age was reduced by twenty-five
per cent.
In examining drops of fermenting wine under
the microscope, Pasteur found them teeming
with minute bodies which he called micro-or-
ganisms. He placed a few drops of fermenting
wine into wine that had been treated, and in
a few days when a drop was placed under the
microscope, it was a seething mass of micro-
organisms. He concluded that the minute cells,
which he had seen under the microscope, were
living things and that they were the cause of
fermentation. From this he deduced his famous
dictum, “Life springs from life,” and therefore
there was no such thing as the spontaneous
generation of life.
Having solved the problem of “sick wines”
Pasteur was called upon to study an epidemic
in silk worms, which threatened to destroy the
great silk industry of France, centered at Lille.
He worked for five long years studying sick
silk worms. He found micro-organisms in the
bodies of the afflicted worms, which he believed
to be the cause of two diseases, pebrine and
flacherie; and he advised methods of preven-
tion which when applied, ended the epidemic
and saved many millions of dollars a year to
growers of silk worms and manufacturers of
silk.
Fielding Garrison, in his monumental history
of medicine, said: “Pasteur suffered from the
cavillings of lesser men.” Unfortunately he was
forced to give time to bitter controversies when
he wanted to be working on important prob-
lems. Liebig of Germany attacked his dictum
of “Life springs from life”; and in France
Felix-Archimede Ponchet defended the theory
of spontaneous generation of life. The contro-
versy continued for several years when Pas-
teur, in a masterly presentation of his studies
on fermentation and putrefaction, persuaded
the Academy of Sciences in Paris, in 1862, of
the correctness of his conclusions.
Pasteur’s critics pursued him, and he worked
for a time under great difficulties. Two of his
daughters died, and in 1868, when he was
forty-six years of age, he had a cerebral
hemorrhage. He was partially paralyzed on his
left side for the rest of his life. When he was
discouraged almost to the point of giving up
his researches, the French government pro-
vided him with a laboratory and the munifi-
cent annuity of five hundred dollars with which
to continue his work. Pasteur isolated the
micro-organisms of chicken-cholera and made
cultures of them in a medium of meat broth.
By adding a few drops of the culture to bread
and giving it to healthy fowls, he produced’,
the disease in them in a virulent form. He
observed that in using cultures which had not
been renewed for several weeks, when given
to chickens, they had a mild form of cholera,
from which they recovered. He later tried te
produce cholera in those chickens, and could
not. He then used the attenuated cultures to
produce immunity — to cholera in chickens.
Thus was born the principle of vaccination with
attenuated bacteria and viruses to prevent con-
tagious and infectious diseases.
A Case of Congenital Anomaly of the Female
Urethra and Vagina
' C. C. HIGHTOWER, M.D.
■ aKi
* Hattiesburg, Mississippi
Mrs. A. C. M. age 22, came to my office
with a history of never having had a
normal menstruation. Each month she
had a black discharge lasting two weeks and
accompanied by pains in the pelvis. She had
been married two years and coitus was satis*
factory.
On vaginal examination, which happened to
be at a time when there was no black dis-
charge, the vagina was found to be normal in
depth and in every respect except that the
cervix could not be palpated or seen and the
vagina terminated in a blind pouch lined by
normal vaginal mucous membrane. On deep
pressure the uterus could be palpated above
the vaginal dome but whether the cervix was
patulous, or covered by mucous membrane,
could not be determined. It could not be de-
termined where the black discharge came from
each month.
Having decided that an operation would be
necessary, a catheterized specimen of urine
was secured but with great difficulty. It wag
found that the urethra was not in its normal
position but on the anterior vaginal wall near
where the cervix should be, as shown in the
accompanying diagram.
What could be done had to be worked out
at operation. It seemed advisable to cut
through the dome of the vagina, find the cer-
vix, dilate it, and cover it over with mucous
membrane, if possible, and if not do a hysterec-
tomy. .
At operation two weeks later, when the
black discharge was again present, on insert-
ing the vaginal speculum the source of the
discharge was discovered. There was a pin-
point opening in the dome of the vagina whict
was so small that it could not be detected ex-
cept for the black discharge. The opening was
dilated with a small probe and it was soon
discovered that the vagina was divided into
two parts by a septum lined above and below
by normal vaginal mucous membrane. The sep-
tum was removed. A normal cervix and uterus
was found above the septum. Nothing could
be done with the abnormally situated urethra.
The passage of the urine through the vagina
seemed to cause no trouble before or since
the operation.
Since the operation the menses have been
normal and the patient cured of all dysmenor-
rhoea. The dysmenorrhoea, of course, was due
to the obstruction to the menstrual flow. It
required two weeks for the accumulated blood
above the vaginal septum to pass through the
minute opening in the septum.
The man who has nothing to boast of but
his illustrious ancestors is like a potato — the
only good belonging to him is underground.
— Sir Thomas Overbury ( 1581-1613..
398
Surgery and Diabetes*
H. B. SUTHERLAND
Booneville, Miss.
wenty-three years ago this combination
was serious. Today it is vastly different.
Thousands of diabetics owe their lives to
the discoverer of insulin — Sir Frederick Bant-
ing. We are all familiar with his tragic death
which occurred on February 21, 1941. To him
goes the credit of this life-saving fluid. To
Eli Lilly and Company and the University of
Toronto’s scientific group goes the credit for
perfecting insulin and the reduction in the
price whereby no diabetic today need be de-
nied treatment due to high cost.
Since the advent of insulin in 1922 surgery
and the improved treatment have prolonged
the lives of patients with the dreaded infec-
tious and gangrenous lesions of the feet far
beyond the year they would have lived with-
out insulin.
Surgery before insulin was a hazardous un-
dertaking. Very few diabetics survived an
operation before insulin. Very few surgeons
would undertake to perform one.
As we all know, infections in diabetes always
make the diabetes worse. The surgical diabetic
is always the serious diabetic and the diabetic
who dies. When any type of infection begins,
it is necessary to increase the frequency and
the amount of the dose. Many think that be-
cause the patient is not eating, the insulin
should be reduced or even discontinued. No
worse mistake could be made. To do either
is to invite coma.
An important factor in the prognosis of sur-
gical diabetes is whether he has had treat-
ment prior to the development of surgical
conditions. A diabetic who knows he has the
disease and neglects it puts himself in a dis-
astrous condition. The same may be said of
a diabetic who is unaware of bis trouble. It is
disheartening to find so many diabetics who
are negligent of their disease. I never fail to
encourage them to remain on the treatment
and at the same time to sound a note of
warning of the grave consequences to expect
if the rules are not carried out to the letter.
Sometimes even with encouragement and warn-
*Read before the quarterly meeting of the North-
east Mississippi Thirteen Counties Medical Society.
Starkville. June 1945.
ing the treatment is permitted to lag. Some-
times it takes coma or a gangrenous foot to
make the dangers realized.
A surgical diabetic requires a great deal of
attention. He must have detailed and intimate
treatment. A surgeon unfamiliar with insulin
should not undertake alone the care of a dia-
betic. It has been our custom for one of us
to take care of the wound and the other to
take care of the diabetic condition. In this
way each can consult the other. If the sugar
rises the surgeon must make certain that the
site of operation is not giving trouble. If not,
the cause of the hyperglycemia must be sought
elsewhere.
The frequency of surgery in diabetics is
steadily increasing. This is probably due to the
fact that more diabetics live longer, and natur-
ally more surgical diseases present themselves.
Then too, elective operations can be done be-
cause improved medical methods make opera-
tions of election safe.
There is hardly an operation done today
that cannot be done on a diabetic from ton-
sillectomy to any type of laparotomy. The
mortality from these operations is being
lowered each year. However, it appears there
could be some rise in mortality for this reason :
more diabetics live longer; and more cancers
develop requiring surgery, and an aged dia-
betic with carcinoma must necessarily increase
the percentage. The same holds true for
diabetics who have had the disease a long
time because arterio-sclerosis is prone to de-
velop.
It has been our experience and that of others
that if we have a clean wound and the dia-
betes is under control, there is very little
danger of infection. As has been said, in-
fection makes the diabetes worse. Control the
infection and improvement sets in. If a pa-
tient who has had an operation and whose
diabetes has been under control should begin
to show sugar, we know he has an infection
somewhere because of the loss of carbohydrate
tolerance. Remedy this infection and the sugar
will promptly clear. The presence of sugar
itself may not be so serious but acidosis is. (We
do not want either). It is believed that the
399
400
Surgery and Diabetes — .Sutherland
August, 1945
presence of sugar is not a great hindrance to
healing nor does it predispose to infection, but
it is the infection itself which makes the dia-
betic worse and produces the hyperglycemia
and acidosis.
The surgical diabetic who lives is the one
who had. an early diagnosis and the treatment
is warranted. If the operation is an emergency,
perform the operation and treat the diabetes
later. Of course it would be better to have the
patient sugar free and free of acidosis, but
a fulminating appendicitis cannot afford to
wait.
An example: Mr. F. H., aged forty-seven
years, entered the hospital complaining of
typical symptoms of appendicitis. These symp-
toms had been present two days. Neither he
nor we knew he was a diabetic until a routine
urinalysis revealed orange colored urine. A
blood sugar reported was 240 mgs. per 100 cc.
He was given forty units of regular U-40 in-
sulin. The operation was immediately per-
formed under sodium pentothal, removing an
acute, ulcerative, gangrenous appendix. The
pentothal sodium was given, using normal sa-
line to keep the needle open. After the opera-
tion the rest of the 1000 cc. of saline was al-
lowed to enter. Four hours later he was given
only five units of insulin because the test color
was only a greenish-yellow. His urine was
tested at every voiding. He did not show any
more sugar until three days had passed. The
first twelve hours he had only water. Then he
was given coffee and tea and clear beef broth
for the next twenty-four hours. To that was
added fruit juices. At the end of forty-eight
hours he was given toast with his broth. The
sugar shown on the third day was a yellow-
green with no acetone. He was given eight
units of insulin. This was at noon. In the eve-
ning the test was greenish-yellow and he was
given five units of regular insulin. During
this time he was being given freely of drinks
and toast to maintain his carbohydrate in-
take. If a surgical diabetic is not doing well,
look to his carbohydrate intake no matter
whether he is sugar or acetone free or not. This
must be maintained at 150 grams daily. This
is very important. A sample diet is usually suf-
ficient as: carbohydrate 150 to 160 grams;
protein 75 grams; and fat 90 grams.
On the fourth day he was given stewed
chicken, English peas, potatoes, toast and tea.
At this time he was taking eighteen units of
insulin daily, as his diet was increased the
insulin was increased. By (the end of the fifth
day he was taking thirty-two units in divided
doses, seventeen units in the morning and fif-
teen units in the evening. During this time his
temperature had not been over 99.6 except
his admission day when it was 100.5. Pulse
rate ranged from 120 on admission down to
eighty on the fifth day. On the sixth day
twenty-four units were required. On the
seventh day twenty-two units were necessary.
On the ninth day and the day of discharge
he took fifteen units. He has been on fifteen
units since that time, eight units in the morn-
ing and seven units in the evening.
I did not change him to protamine zinc in-
sulin as I would have done ordinarily. His
mental condition would not permit too much
confusion in the transfer and he was perfectly
satisfied by taking two injections daily. We
are aware of the fact that when an infection
starts it is advisable to switch protamine to
regular insulin. Due to the fact that protamine
acts slower than regular insulin, the dia-
betic cannot be brought under control because
the infection makes the disease rapidly worse.
Regular insulin has quicker effect and does
not last as long and can be often repeated.
In this manner the sugar can be better con-
trolled.
If the operation is elective, it is all right
to get the patient sugar free. Give him plenty
to eat because carbohydrate must be stored in
the body. Feed him up to twelve hours of the
operation and as soon after operation as pos-
sible. A diabetic should be filled with fluids
the day before operation just as much as the
day after. Maybe more so. There are very few
diabetics who do not need an injection of sa-
line in the vein or subcutaneously before an
operation.
There are times when it is necessary to give
a surgical patient intravenous glucose, if pro-
longed under-nutrition is present, if acidosis
persists, if dehydration is present, if the blood
has insulin circulating in it and if the patient
is not able to tolerate glucose by mouth.
If the patient has been taking insulin and
an operation is necessary, give the same dose
of insulin he ha>s been taking in twenty-four
hours, at the time of operation. After that
continue the same number of units, but break
up the total dosage into smaller, more fre-
quent doses, irrespective to meals.
August, 1945 f - • Surgery .ai^d Diabetes — Sutherland 401
It is safer to give this way than to give
larger doses at infrequent intervals. The fre-
quent intervals should be three to four hours
apart, and sometimes two to eight hours. The
tolerance during convalescence can be tested
by raising or lowering the dose. Usually the
noon dose first, then the evening dose.
Older diabetics may be relatively unaffected
by insulin and we must not forget the dangers
of reactions. This may occur when no food is
being given and glucose is being given by vein.
In this case the caloric intake is low and a
moderate dose of insulin may be too much.
This next case in a surgical diabetic is pre-
sented especially because she is an identical
twin. It is my understanding that no great
number of diabetics in identical twins has been
reported. This may not be correct.
These girls developed diabetes when six
years of age and within six months of each
other. They have had several childhood dis-
eases and with very little change in the in-
sulin dosage during this time. Both had their
tonsils removed when nine years of age. It
has been our custom to keep in the hospital
three days the ones who have had their ton-
sils removed.
In November 1942 one of these girls de-
veloped symptoms of acute appendicitis. She
was then twelve years of age. The urine tested
an orange color and the acetone was three
plus. She was suffering so intensely that time
was not taken to run a blood sugar. Under
ether anesthesia the abdomen was opened and
there was found an acute diverticulitis of the
Merckel type. This was adhered to the small
bowel causing a partial obstruction.
She had thirty-five units of regular insulin
that morning and no insulin was given at this
time but she was given 500 cc. of lactate,
Ringer’s solution in the vein. The operation was
performed at 2:00 p.m. and at 8:15 p.m. she
was given another 500 cc. of lactate, Ringer’s
solution. At this time she had a greenish-yellow
test with no acetone and only seven units
were given. Every voided specimen was ex-
amined. Due to the fact that she had but very
little sugar and from two-to-three-plus acetone,
she was given by mouth saline with 10 per
cent glucose, two ounces every hour for twenty-
four hours. Seven units of insulin every four
hours took care of the sugar, and the acetone
promptly cleared. The next day fruit juices
were given. The diabetes was then controlled
with twenty-four units for the day and ten
• . • r •• f. ' !
at night. On the third day she was given
toast, scrambled egg, bacon, corn flakes and
whole milk. Ten units of insulin were given.
This was soon increased to fifteen units before
V’l i.'.
each meal. The nurse was instructed t,Q. follow
this color chart: orange fifteen units; yellow
ten units; yellow-green eight units, green-yel-
low five to seven units; green five units; and
blue no insulin. This test is made before each
meal and the insulin is given fifteen minutes
before each meal. If the orange color does not
change then, the dosage must be increased.
As her normal diet was approached the dosage
was increased until she was receiving twenty
units before breakfast, twenty-five at noon,
and fifteen in the evening, none at night. She
was discharged on the tenth day taking sixty
units. Today these young ladies are sixteen
years of age and are the picture of health.
In the beginning of the disease they were
put on the regular insulin and later transferred
to protamine. For some unsatisfactory reason,
we could not control the disease and they were
returned to the regular form. They are taking
each fifty-four units daily, thirty-two in the
morning and twenty-two in the evening. Some-
times they have a mild reaction during the
night and the best preventive for this is two
crackers with a small amout of peanut butter.
I assure you it is no trouble to get them to
eat it.
We have amputated several legs for gan-
grenous feet. If a diabetic has gangrene of
one of more toes and the dorsal pedis pulsa-
tion cannot be felt, an early decision for a
high amputation should be made. If the pulsa-
tion can be palpated, use an electrically lighted
tent for a while to see whether the zone of
redness fades and if it does, probably a toe
amputation will suffice. If the reddened area
increases, watch closely the dorsal pedis pul-
sation because it may disappear. If much hard-
ening of the arteries is present, it will be
better to amputate above the knee. If the
vessels are in fairly good condition, then just
below will probably be all right. It is better
not to use a tourniquet, but if one is used,
it must not be narrow. Make it as wide as
possible and release it as quickly as possible.
An injury to the vessel constriction may cause
further gangrene to develop. The stump is
closed without drainage. Some surgeons do not
like to close these large stumps without drain-
age, but the only one we had any toruble with
was one that was drained.
402
Surgery and Diabetes — .Sutherland
August, 1945
In twenty-four hours following amputation
the patient feels like a different person. Watch
the sugar after amputation. Sometimes it will
drop to normal and remain there. Therefore
an operation for a gangrenous foot may prove
to be a blessing rather than a curse. Some-
times an infected tooth or an infected sinus
relieved will cause a badly infected foot to
neal. The patient is encouraged to get out of
bed as soon as possible and is taught some
form of exercise to keep the circulation in
good condition. Be sure to give him plenty of
carbohydrates.
If a surgical diabetic does not appear to be
doing well and if he is sugar and acetone free,
then look to the carbohydrate intake. He is
more than likely not getting enough.
At least one-third of the operations on dia-
betics constitute,; the amputation of legs and
toes. Gangren©' usually makes its first appear-
ance around the age of fifty. To see a patient
do well after an amputation is fine, but to
teach one a way to prevent it is better. When
gangrene develops it is usually on the feet.
Teach him to keep the feet cleaner than the
face. Daily baths with care, using a good
dusting powder afterwards, preferably sulfo-
merthiolate surgical powder, has a tendency
to keep down epidermophytosis. The feet should
be exercised daily to improve the circulation.
Keep all wrinkles out of the socks, change the
socks daily, and be sure there are no tacks or
rough edges in the shoes.
I will only mention the anesthetics. I would
like to say in the beginning that we use sodium
pentothal in all the operations possible. We
have not yet used it in children nor have we
used it for tonsillectomies. Ether is used for
them in children and local for grownups. Pen-
tothal does not seem to disturb the metabolism
nor the patient in any way. At the same time
salt solution is given which is needed. Chloro-
form is harmful to a diabetic. It disturbs the
carbohydrate metabolism and alters the fat
metabolism because after chloroform acidosis
resulting in coma is common. We have used
it for short anesthetics to set a fracture, open
an ear drum, and for a delivery. Ether dis-
turbs the metabolism, but probably the great-
est factor is the production of nausea which
interferes with fluid intake. A mild diabetic
may easily bear it. It may change a mild to a
moderate, and a moderate to a severe, and
that could prove fatal. However, with in-
sulin this could be avoided. I have not
had experience with nitrous oxide or cyclo-
propane, but I understand both are used satis-
factorily at other places. We have not had any
ill results with ethylene. We have had good
results with spinal using pontocaine or pro-
caine. Local anesthesia, when it can be used,
works well.
Those who are most servile in their flatteries
in time of prosperity become the loudest in
their invectives and execrations in time of mis-
fortune.
He is a wise man who can see through his
enthusiasm the right status of his labors, with-
out being blinded by egotism.
He is a wise man who, when the world is at
his feet, can still see in the common people
the true light of his success.
Beware of the man who tells you he is hon-
est.— Anderson M. Baten.
§
Some doctors are opposing a four-year medi-
cal school in Jackson, thinking they will have
no practice left. Does Jackson utilize all the
health service? Does Oxford soak up all the ^
University education? Does Meridian get all
the mental therapy from the insane hospital ;
located there? Does Columbus get overdosed
with female education from M. S. C. W. ?
August, 1945
403
The Mississippi Doctor
Published monthly at Booneville, Mississippi
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
Official Organ Of
Mid-South Postgraduate Medical Assembly
Mississippi State Medical Association
W. H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton. Blue Mountain College Poet
Mid-South Postgraduate Medical Assembly
Officers :
C. El. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M. D Vice-President
El Dorado, Ark
A.. F. Cooper Secretary -Treasurer
Memphis. Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis. Tenn.
Editors :
Fay H. Jones, M.D. E. M. Holder, M.D.
C. R. Crutchfield. M. D. C. M. Speck, M.D.
H. King Wade, M. D. F. M. Acree, M.D.
Mississippi State Medical Association
Editor
Lawrence W. Long, M.D.
Associate Editors
J. G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life Building,
Jackson, Mississippi
A MEDICAL SCHOOL
In higher medical circles, by tongue and in
the medical literature, we note the remark,
“Sickness is a responsibility of the local com-
munity.” This is only partially true; it’s the
responsibility of the entire nation. In many in-
stances the very best arsenals of manpower
are short on finances for health. It is good
human economy for all the people to have the
best there is in medicine. This can be supplied
without breaking the personal relation between
the doctor and the patient. We would never
have had a system of through highways if we
had had to wait on the poorer sections to fill
in the links. We cannot have an all-out health
building program without national aid, and
state, church and philanthropy doing their
part. The poor areas of the South are furnish-
ing most valuable manpower to the entire na-
tion, and it is only fair for some of this to
come back to keep the arsenal going.
§
Excerpts and comment from an editorial
in the Aberdeen Examiner, one of the state’s
outstanding county papers :
A comprehensive survey has just been
made of the state’s colleges, made with a view
apparently to further some special interest.
It looks like there might be some truth in this
as far as it applies to the four-year medical
school. The interest outside the state of Mis-
sissippi not having a medical school seems to
be pretty strong.
Mississippi now has five state-owned
charity hospitals, and our information is that
there are only six such hospitals in the United
States. We believe this system is wrong; these
state-owned hospitals should be given to the
counties as community hospitals, then the state
should support charity wards in the various
community hospitals of the state.
In the above statement Editor Sanders ex-
presses the opinion of many. This journal has
advocated this idea along with the per capita 1
distribution of funds for fifteen years without
a let-up. Yes, we have five state-owned charity"
hospitals poorly equipped and politically op-
erated mainly for five counties in the state
at the expense of eighty-two counties. The
slate has been for many years, beginning with
Governor White’s administration, supporting
wards in all the hospitals in the state that
want the support. The amount allowed has
not been as much is it should have been, but
it has served a great need and has laid the
foundation for a hospital system and a medical
school that might well take the lead in the
United States for service. The time has come
for medical science to serve the people instead
of the people serving medical science. Going
to the big centers for all medical service and
all medical teaching contains about as much
reason as there would be for Mr. Sanders to
print his papers and expect his subscribers
from over the county to come and get them
404
News and Comment August, 1945
each week, or for the post office to receive
its mail and never deliver any, or for electricity
to confine its light to large cities. The time
for a decentralization and a sensible distribu-
tion of doctors and their services is at hand.
A survey should be made of the doctor
shortage — but we would have to wait until
1960 when a new school could provide doc-
tors.
Surveys may be all right, but the doctor
shortage is so evident that it is just as certain
as the rising of the sun. Mississippi has had
two thousand doctors at times, but there
are not more than five hundred really able
and active men who can stand the strain now.
We have men who have had their high school
work and could enter college pretty soon, we
have some who have had their premedical work
who could enter, and within a year’s time we
could be offering internships if we had a
Correlated system with a central hospital. In-
terns could render a fine service in the state
at this time. A very large percentage of them
should serve their last six months in a com-
munity or small city hospital and with a part
of this time under the direct supervision of a
good practitioner.
Mississippi is financially able to own and
operate a medical school if it wants it and
it does not have to do it with three five-hun-
dred-bed hospitals. Financially, socially, or
physically we cannot stand the cost of family
travel, the fees, and the privation on this propo-
sition. Eighty-five per cent of sickness in our
state should be treated by eighty-five per cent
of our doctors in about eighty-five community
hospitals or in the homes nearby. It will never
be done by a supercentralization plan promoted
by super-specialists of limited experience. A
system of hospital service that would carry a
real consultant out to each county every month
in the year to meet with the local doctors and
discuss with them their complicated cases, to
give and receive medical knowledge, should be
one of the big advances in our medical service
set-up.
(The following argument from Dr. D. W.
Jones of Jackson expresses the sentiment of
many physicians over the state.)
Shall we hold our 1946 convention of the
Mississippi State Medical Association? >
Yes, by all means. And it ought to be one
of the best in the history of our Association.
World history has been very much in the
making since our last regular meeting, and
there have been many new developments in
medicine and surgery.
We are anxious to hear discussions of these
new things and to meet with our fellows a-
gain. My suggestion is that the meeting be
given over almost,, altogether to our boys re-
turning from the fields of war, with a few
special numbers by outside guests who have
distinguished themselves in their specialities.
Should there still be restrictions on railroad
travel our doctors can get plenty of gas and
can come in their cars. Should hotel accom-
modations be crowded, our Jackson doctors
stand ready to open their homes to our fellow
members.
Let us begin now to make plans for the best
meeting in the history of the Association next
May.
NEWS AND COMMENT
Meridian Surgeon Hurt
Meridian, Miss., August 5. — Dr. Leslie
V. Rush of Meridian, one of the South’s
outstanding bone surgeons and co-head of
Rush’s Infirmary of Meridian, received a
broken back at his residence on Polar
Springs Drive when he was thrown to the
ground from a horse. Removed to Rush’s
Infirmary, he was placed in a cast by his
brother, Dr. Lowry Rush. It was said he
will have to remain in this cast for at
least two months and wear a brace for an-
other period of some eight months.
— Commercial Appeal
This news is received by the medical pro-
fession of our state with deep regret. The Rush
Brothers, Leslie and Lowry, are holding high
the banner of medicine both in efficiency and
in medical integrity.
Dr. Alphonse McMahon, St. Louis, captain,
Medical Corps, U. S. Naval Reserve, chief of
medical service, U. S. Naval Hospital, Beth-
esda, Maryland, was assigned to look after the
health of President Truman and his party on
their trip to Germany for the Big Three Con-
ference. Dr. McMahon is a former president
of the St. Louis Medical Society and a former
member of the Council of the Southern Medi-
cal Association representing Missouri and is
a past chairman of its executive committee.
Deaths
405
August, 1945
Dr. J. Rice Williams of Houston, beloved
Abraham of the medical profession in the
state, held a ritualist school of iristirfilction for
Blue Lodge degree teams, Augll&t 7 to 10. It
was attended by Masons from east and central
Mississippi. Dr. Williams is the able and popu-
lar speaker of the House of Delegates of the
Mississippi State Medical Association.
ANNOUNCEMENT
Due to transportation difficulties the ex-
amination of the American Board of Ophthal-
mology, originally scheduled for Chicago, Oc-
tober, 1945, has been postponed to January
18 to 22, inclusive, 1946.
1946 examinations: Chicago, January 18-22;
Los Angeles, January 28-Feb 1; New York,
May or June; Chicago, October.
Albert J. Mcllwain, M.D., announces the
opening of offices for the practice of x-ray
diagnosis, x-ray and radium therapy, T45
North State Street, Jackson 6, Mississippi.
Office hours 8:00 to 5:00. Telephone 3-3412.
MEDICAL EXAMINATION NOTICE
The Mississippi State Board of Health will
hold medical examinations on September 27
and 28, 1945 in Jackson, Mississippi, (12th
Floor, Robert E. Lee Hotel).
Examinations may be taken on the first
two years only, as well as on all four years
of medicine (or the last two years for those
who have passed the first two years before
this Board.)
For application blank and other information
address: Dr. R. N. Whitfield, assistant secre-
tary, Mississippi State Board of Health, Jack-
son 113, Mississippi.
Deaths
DR. S. E. DUNLAP
Dr. Shirley Edward Dunlap, a resident of Wig-
gins since 1912, and since its organization, December
4. 1916, president of the Bank of Wiggins, died in
Touro Infirmary in New Orleans, La., Sunday, June
10 after an illness of several months. He was born
at Pulaski, Tenn., on January 8. 1879, and came
to Mississippi after receiving his medical degree
from the University of Nashville in 1906, and began
the practice of medicine at McLaurin, Miss.
He was a member of the Presbyterian church, a
Mason and a charter member of the Wiggins Rotary
Club.
Dr. Dunlap w'as the youngest of the five children
of Thomas Franklin and Ella Smith Dunlap. He is
survived by his widow', Bess Henry Dunlap’, a
brother, W. P. of Pulaski, a sister, Mrs. J. K.
Alexander of Decatur, Ala., and a number of nieces
and nephew's.
Interment was at Pulaski on June 13.
DR. J. A. ALEXANDER
Dr. James Albert Alexander died on July 21,
at the Veterans’ Hospital in Memphis, after a long
and useful life, the greater part of which wras spent
in Indianola.
He was born in Bolton on May 29, 1866, and
was a graduate of Mobile Medical College, Mobile,
Ala., and did postgraduate w'ork at Johns Hopkins
LTniversity in Baltimore. He wras a veteran of the
Spanish-American War.
On January 25, 1900, he married Miss Josie
Birdsong, and in 1901 they moved to Indianola,
where he entered the practice of medicine and re-
mained here, ill health forcing him to retire about
four years ago. Much of the latter time he was
confined to bed and received treatment in Hines Hos-
pital in Hines, 111., but for the last two months had
been in the Veteran’s Hospital in Memphis.
He was the son of Dr. and Mrs. James Alexander
of Bolton.
He wras one of the pioneer citizens of Indianola.
and meant much to the community, having been
a member of the board of stewards of the Methodist
church, of which he was a member and active in all
civic and social affairs of Indianola.
He is survived by his wrife and one daughter,
Mrs. Paul Thomas of Spartanburg, S. C. ; two grand-
daughters, Patsy and Ann Thomas.
DR. JOHN W. PRIMROSE
Funeral services for Dr. J. W. Primrose, wide-
ly known physician of north Mississippi, were held
at Clarksdale July 18.
The remains were taken to Greenville for in-
terment.
Dr. Primrose died after several days of critical
illness. He had been in failing health for several
years.
Dr. Primrose had resided in Clarksdale for forty
years. He w-as a graduate of Memphis Hospital
Medical College, 1902.
Surviving is his son, Lieut. John W. Primrose,
w'ho is a navigator-instructor overseas, and three
sisters.
DR. R. A. SWITZER
Death came, after a short illness, following a
heart attack to one of Stone County’s best bene-
factors and friends. Dr. Ross A. Switzer, at his
country home near McHenry July 24. Active up
until the attack, he was stricken w'hile attending a
patient. He served on the board of supervisors,
representing Beat 4 almost thirty years, most of
that time being its presiding officer. Dr. Switzer was
a friend of those less fortunate than himself and gave
of his time and means to help suffering fellow citi-
zens.
Dr. Switzer was born in Rochester, New’ York,.
November 30, 1875. He moved to south Mississippi
over fifty years ago, residing in McHenry the past
thirty-five years, where he actively practiced his
profession. He was a member of the Methodist
church and the Masonic Lodge. He was graduated
in 1902 from Chattanooga Medical College.
Surviving are his widow, Mrs. Annie L. Switz-
er, one daughter, Mrs. Virginia Mustin, McHenry;
one grandson, Glenn Switzer Mustin, and twV)
nephews; Fred W. Switzer, Aruba Curacoa, West
Indies, Edison Perry, Philadelphia, Pa., and one
niece, Mrs. Esther Burns, Buffalo. New York.
CONSTRUCTIVE PROGRAM FOR MEDICAL CARE
AMERICAN MEDICAL ASSOCIATION
This platform was adopted by the Council on Medical Service and Public Relations and the
Board of Trustees of the American Medical Association, on June 22, 1945
Preamble
The physicians of the United States are interested in extending to all people in all
communities the best possible medical care. The Constitution of the United States, the Bill
of Rights and the “American Way of Life” are diametrically opposed to regimentation or
any form of totalitarianisms According to available evidence in surveys, most of the Ameri-
can people are not interested in testing in the United States experiments in medical care
which have already failed in regimented countries.
The physicians of the United States, through the American Medical Association, have stressed
repeatedly the necessity for extending to all corners of this great country the availability of aids
for diagnosis and treatment, so that dependency will be minimized and independence will be stimu-
lated. American private enterprise has won and is winning the greatest war in the world’s history.
Private enterprise and initiative manifested through research may conquer cancer, arthritis and
other as yet unconquered scourges of humankind. Science, as history well demonstrates, pros-
pers best when free and unshackled.
Program
The physicians represented by the American Medical Association propose the following con-
structive program for the extension of improved health and medical care to all the people :
1. Sustained production leading to better living conditions with improved housing, nutri-
tion and sanitation which are fundamental to good health; we support progressive action toward
achieving these objectives:
2. An extended program of disease prevention with the development or extension of or-
ganizations for public health service so that every part of our country will have such service,
as rapidly as adequate personnel can be trained.
3. Increased hospitalization insurance on a voluntary basis.
4. The development in or extension to all localises of voluntary sickness insurance plans
and provision for the extension of these plans to the needy under the principles already estab-
lished by the American Medical Association.
5. The provision of hospitalization and medical care to the indigent by local authorities
under voluntary hospital and sickness insurance plans.
6. A survey of each state by qualified individuals and agencies to establish the need for
additional medical care.
7. Federal aid to states where definite need is demonstrated, to be administered by the
proper local agencies of the states involved with the help and advice of the medical profession.
8. Extension of information on these plans to all the people with recognition that such
voluntary programs need not involve increased taxation. o
9. A continuous survey of all voluntary plans for hospitalization and illness to determine
their adequacy in meeting needs and maintaining continuous improvement in quality of medi-
cal service.
10. Discharge of physicians from the armed services as rapidly as is consistent with the
war effort in order to facilitate redistribution and relocation of physicians in areas needing
physicians.
11. Increased availability of medical education to young men and women to provide a
greater number of physicians for rural areas.
12. Postponement of consideration of revolutionary changes while 60,000 medical men are
in the service voluntarily and while 12,000,000 men and women are in uniform to preserve the
American democratic system of government.
13. Adoption of federal legislation to provide for adjustments in draft regulation which
will permit students to prepare for and continue the study of medicine.
14. Study of postwar medical personnel requirements with special reference to the needi
«f the veterans’ hospitals, the regular army, navy and United States Public Health Service.
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. P. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
DERMATOLOGY
Archives of Dermatology and Sy philology,
Viol. 51; No. 5; May 1945.
Prevention of Impetigo Neonatorum :
Clinical Study of Various Methods Includ-
ing the Use of a New Antiseptic Baby Lo-
tion. Carl C. Fisher, Arch. Pediat. 61:352.
The problem of prevention of epidemics of
impetigo neonatorum has been a major one
in hospitals for many years. The quest for a
satisfactory solution to this problem is still
going on. In reviewing the literature for the
past twenty-five years, the author finds that
the suggestions to solve this problem fall into
two main groups: (1) those which detail vari-
ous technics designed to minimize the possi-
bility of infection of the skin of the newborn
infant by causative agent or agents of this
disease (“no bath technic” by eliminations of
trauma of daily cleansings) ; (2) those which
recommend the use of various antiseptics to
protect the skin of infants against such in-
fections (external antiseptics, ointments such
as ammoniated mercury, sulfonamide com-
pounds and antiseptic oils, the antiseptic ac-
tion of which depends on hydroquinine, hy-
droxyquinoline or clorobutanol present in oils).
It is generally agreed on in the prophylaxis
of this infection that the best results would
follow the use of (1) a technic which would
minimize traumatization of the skin of the
newborn infants as much as possible and (2)
an antiseptic agent which has the advantages
of (a) easy application, (b) freedom from irri-
tative and sensitivity reaction and (c) ability
to inhibit the growth of infecting organisms.
In the author’s comparative study of the three
methods of prophylaxis against this disease
over a period of seven years on more than
4,000 infants, including premature infants, he
showed that there was a material decrease in
the incidence of infection by use of a modifica-
tion of the “no bath technic” in which no at-
tempt was made to remove the vernix caseosa
or trimethyl ammonium bromide) be applied
freely from birth, with special attention to
groins, axillas and folds of the neck. The emol-
lient preparation (lotion) can be applied with
less trauma. Patch tests an dother tests with
various dilutions of the antiseptic ingredient
in the lotion showed that it was not irritating
and did no produce sensitivity reactions.
Gelber, Los Angeles.
PEDIATRICS
Efficacy of Whooping Cough Vaccine.
Garvin, Justin A., Ohio State Medical Journal,
March, 1945.
“In a prvious paper data were presented
comparing the incidence of whooping cough
in children under five years of age in two
adjacent cities. One of the cities, Cleveland,
with a population of about 900,000 had a small
percentage (estimated 10 per cent) of its pre-
school children immunized against whooping
cough by vaccine, while the other city, Shaker
Heights, an adjacent residentiol suburb of 25,-
000 people, had a high percentage (estimated
75 per cent) of its preschool population im-
munized against whooping cough, mostly ac-
cording to the method recommended by Sauer.
“Tables and a graph were presented show-
ing the incidence of prescchool pertussis in
each of these cities for a period of five years
(1929-1933) before immunization was started
and for a subsequent period of six years (1934-
1939). The conclusion arrived at was that
the use of whooping cough vaccine (Sauer’s)
as a prophylactic seemed justified.
“During the past four years (1940-1943)
data similar to that obtained for the preceding
eleven years has been obtained for the entire
fifteen-year period.
408
Interpreting Medical Literature
August, 1945
“The prophylactic immunization of Shaker
Heights infants against whooping cough has
continued at a high rate, being done now as
routinely as immunization against diphtheria
and smallpox. In metropolitan Cleveland there
has been a moderate increase in the number
immunized against whooping cough due to the
efforts of private physicians as its child health
centers and hospital outpatients departments
generally do not immunize against whooping
cough.”
“In the past four years the incidence of pre-
school whooping cough in Shaker Heights has
continued at a stable low level while its inci-
dence in Cleveland averages slightly lower
than before.
“The records of the health department of
suburban Shaker Heights show two other items
of interest concerning whooping cough.
“1. None of the cases (6) of preschool
whooping cough reported in 1943 had re-
ceived prophylactic immunization against the
disease.
“2. During the past three years (1941-43)
a total of ten cases of whooping cough have
been reported in children over five years of
age.” Added to the seventeen cases in this
priod reported in children under five years of
age, a total of twenty-seven cases of whooping
cough in children of all ages in three years’
time is obtained.
Apart from data presented in this paper,
the writer finds confirmatory evidence of the
efficacy of vaccine in preventing whooping
cough in not having encountered during the
past eight years a single case of his private
practice among children whom he had im-
munized against the disease, according to Sau-
er’s recommendations, subsequent to the year
1935.
It is concluded that the prophylactic immuni-
zation of infants and young children against
whooping cough by private physicians and pe-
diatric clinics in health centers and hospitals
should be as standard practice as immuniza-
tion against diphtheria and smallpox.
COMMENT
The efficacy of whooping cough vaccine as
a preventive measure has been thoroughly
established by many who have had experience
with its use since it was placed on the market.
There should no longer remain any doubt in
the minds of any physicians about this and
every practitioner should give it to all children
between the age of four and six months be-
cause it is well-known that whooping cough
in children under a year old is a very serious
disease, in fact, much more so than practically
any other contagious disease in childhood.
It has been our practice to give whooping
cough vaccine to infants within the first month
of age if it was directly exposed to the disease.
The reacion from our experience is no greater
in a very young infant than that of an older
infant and it is well-known that in an infant
less than two months of age, the mortality rate
is very high. We would suggest that all prac-
titioners keep this in mind when such exposures
exist. The immunization of all diseases among
infants and children primarily belongs to the
private practicing physician as well as the
Public Health Serivce, and if more private phy-
sicians would do more preventive work, it would
be less burdensome for the Public Health Ser-
vice and at the same time keep the preventive
work in its normal channel where it properly
belongs.
BOOKS WANTED
The Medical and Surgical Relief Committee
of America has received an appeal for medical
books from Dr. Severinghaus, member of the
Medical Nutrition Mission in Italy. The Mission
has set up in a hospital called the Polyclinica
which is part of the University of Naples. The
books are for the use of the Mission. Later it
is intended to donate them to the Pediatric
Clinic library.
The list of books requested is as follows:
1. R. P. Strong: Stitt’s Diagnosis, Preven-
tion, and treatment of Tropical Diseases —
Seventh edition. 2 volumes. Blakiston.
2. Conant, Martin, et al.: Manual of Clinical
Mycology. Saunders.
3. Saxl: Pediatric Dietetics. 1937. Le and
Febiger.
4. Brennerman’s loose leaf Pediatrics. Nel-
son, 4 volumes.
5. Best and Taylor: Physiological Basis of
Medical Practice. Williams and Wilkins.
6. McLester: Clinical Nutrition and Dieto-
therapy. Saunders.
7. Miller: Oral Diagnosis. Blakiston.
8. Peters and Van Slyke: Quantitative Clini-
cal Chemistry. Williams and Wilkins. 2
volumes.
State Board of Health
Felix J* Underwood, M .D.
A SURVEY OF THE INCIDENCE OF
HOOKWORM INFECTION IN GEORGE
COUNTY, MISSISSIPPI, 1944-1945
R. A. Brannon, Jr., M.D., Curtis E. Miller,
and Z. E. Oswalt
Control and prevention of hookworm dis-
eases has long been an important objective of
the public health program in Mississippi. Much
impetus was given to the development of full-
time local health departments following the in-
tensive work done in this field during 1910-
1914. At that time surveys were made of large
areas of the state under the direction of the
Rockefeller Sanitary Commission1. Another
survey was made in 1932-1933 by Keller,
Leathers and Ricks2. Nickel3 reported the in-
cidence of hookworm in fifty-two counties of
Mississippi based on specimens submitted to
the State Hygienic Laboratory during thirty-
three months of the period 1938-1941. Keller,
Leathers and Densen* did follow-up investiga-
tions for 1930-1938. These represent the in-
cidence of hookworm infection in the state.
Increased interest on the part of both state
and local health departments in more effective
hookworm control led to our making a survey
of the incidence of hookworm disease in George
County for 1944-1945. This county is one of
four located in the southeastern area served
by the Southeastern Health District, the other
counties being Greene, Stone and Perry. Be-
cause of the high percentage of sand in the
soil, the large annual rainfall, and the high
mean temperature, the southeastern area is
ideal ground for the spread and propagation
of the hookworm. George County was selected
from the four counties for the survey because
the central office of the Southeastern Health
District is located at Lucedale, the county
seat.
It was decided that the easiest and most
practicable manner of securing specimens for
the survey would be through the schools. Con-
sequently the county was divided into and
409
worked by school districts. The school officials
were notified in advance of the program to be
carried out, and the teachers upon request
prepared family records for the children, list-
ing the name of each member of the family
together with the ages of the children. Follow-
ing the showing of an educational motion pic-
ture to the children about hookworm disease
and a short talk, hookworm containers for
each member of the family were distributed to
the children together with directions for col-
lecting the specimens and for labeling. The
envelope in which the containers were dis-
tributed carried a letter addressed to the par-
ents pointing out the importance of collecting
the specimens and having them returned to the
school ; also educational materials were in-
cluded. From the school the specimens were
picked up by the health department, refrigerat-
ed, and taken to the State Hygienic Laboratory
at Jackson.
The results of the laboratory reports were
recorded on the family record as soon as they
were received. For the positive cases a pack-
age was mailed to the head of the family, con-
taining single dose cartons of tetrachlorethy-
lene labeled with the name of the individual
in whom hookworm infection was indicated.
The package also contained epsom salts for
purgation and explicit directions for taking the
medicine. It was requested that the treatment
be repeated two weeks later. In giving these
instructions, reasonable assurance was had
that the drug would be properly administered.
The therapeutic goal sought was to rid the
individual of the parasite. For this it will be
necessary to follow up on these cases with
repeated tests and treatment as needed.
The laboratory employed the simple smear
method in examining specimens submitted,
and in this regard it should be pointed out that
this method is somewhat less accurate than
the dilution technic used by Keller, Leathers
and Ricks2. Doubtless the rate of infestation
would have been somewhat higher in the pres-
ent survey had the dilution technic been used
410
State Board of Health
August, 1945
and this should be borne in mind when com-
paring statistics for the two surveys.
RESULTS
George County with a population of ap-
proximately 9,000 people had a total of 3,622
specimen containers distributed to both Negro
and white, for the purpose of determining the
incidence of hookworm infection in this area.
The number of specimens collected was 1709,
or 47. 2 per cent of the number distributed.
Of these, 466 were diagnosed as positive, re-
vealing an incidence of hookworm disease
among the white population of 29.1 per cent.
Table I shows the incidence of infestation
of adults ( twenty-one years and over) to be
19.5 per cent. The incidence among the group
under twenty-one was 31.7 per cent.
Age
0-20
21 over
TABLE I.
Specimens Per cent
Examined Positive Positive
1233 392 31.7
346 68 19.5
Results of the present study compared with
those of the 1910-1914 survey show that there
has been a decrease in the incidence of hook-
worm infestation of from 82.1 to 29.1 per cent
— a reduction of 64.6 per cent. The reduction
since the 1932-1933 survey, when incidence
was 40.8 per cent, is 28.7 per cent.
TABLE II.
Incidence of Hookworm Disease in the White
Population of George County for Periods,
1910-1914, 1932-1933, and 1944-1945
1910-1914
Total
Per cent
Examined
:: : ; .
positive
789
1932-1933
82.1
Total
Per cent
Examined
positive
1618
1944-1945
40.8
Total
Per cent
Examined
positive
1579
29.1
In summarizing the incidence of hookworm
by age group, there were some striking differ-
ences in comparing with the series reported by
Keller, et al. It should be taken into account,
however, that the figures of this early survey
were based on the totals covering fifty-two
counties, while the present figures are for
George County only. In the early series, the
age group 0-4 had the relatively low infesta-
tion rate of 7.9 per cent. In the George County
study the incidence was 22 per cent for this
age group and the highest rate was found in
the 10-14 group. In Keller’s series the highest
rate of infestation was found in the 15-19 age
group.
TABLE III.
Specimens Positive Per Cent
Age
Examined
Specimens
Positive
0-4
136
30
22
5-9
537
177
32.9
10-14
426
150
35.1
1 5-19
132
35
26.5
20-over
348
68
19.5
Total 1579
460
29.1
In the series in which is was possible to keep
accurate family records, it was disclosed that
of the 338 families tested, 164 had one or
more infested members. The infested families
comprised 48.1 per cent of the total families
examined.
From Table IV it will be seen that 45.7 per
cent of the infested families had but one
positive Member, whereas 54.3 per cent had
two or more. In determining percentages of
total persons infested, it will be noted that
twenty-two per cent were in the group which
had only one infested member per family; the
remainder, or seventy-eight per cent, were in
the groups with two or more per family. Ten
per cent of the patients belonged to the group
having six or more infested members per fami-
ly* " I
August, 1945
TABLE IV.
Number of Infested Persons per Family
411
Number
Percentage of
Percentage
Infested
Number
Infested
Number
of total
Persons
Families
Families by
Persons
Infested Persons
in Family
Infested
Groups
Infested
In each Group
1
75
45.7
75
22
o
42
25.6
84
24.7
o
O
27
16.4
81
23.8
4
9
5.4
36
10.5
5
6
3.6
30
8.8
6 or more
5
3.0
34
10.
It is apparent that less than one-half of the
families produced all the cases of hookworm in-
fection found in the study. Since 78 per cent
of the persons harboring the parasites came
from only 53.3 per cent of the infected families,
the incidence should be considered especially
significant from the family point of view. The
statistics disclose that about 25 per cent of
the total families tested contained 78 per cent of
the cases. It is obvious that when an infested
member is found the entire family should be
examined and measures taken to prevent the
spread of the parasite to other members.
A small survey was also made of the Ne-
groes in the Lucedale area. There were 290
containers distributed to sixty families, of
which 130, or 44.7 per cent, were returned.
Only six of the specimens were positive, re-
vealing an incidence of 4.8 per cent.
The school districts into which George Coun-
ty was roughly divided are shown on Map I,
with the incidence of hookworm infection be-
ing indicated. The results are thought to be
significant in that the Rocky Creek and Agri-
cola districts, both of which are relatively
thickly populated and prosperous, have a much
lower incidence than the poorer and more
sparsely settled districts of Bexley, Salem and
Broom. The two districts of Central and Basin
are intermediate regarding density of popu-
lation, prosperity and hookworm infestation.
As the map clearly illustrates, hookworm in-
fection is a greater problem in the less highly
developed and less prosperous communities.
The Lucedale area actually has a lower rate
of infestation than the 26.9 per cent indicated,
as a large number of the students enrolled at
the Lucedale schools were residents of the
Salem, Bexley, Ward and Central districts. It
is difficult to account for the high infestation
rate in Ward District, unless due to the small
number of specimens examined and the prob-
ability of error in proportion to the total
population.
Cot m\j, sfcoola « school districts, population of — ^ district
•oi p«rcuu{i of pepoiotloB »Uh bookoon iafoctloo.
412
State Board of Health
August, 1945
TABLE V.
Table showing results of hookworm survey.
No of
No. in
Specimens
Positive
Negative
Percent of
School
Families
Families
Examined
Specimens
Specimens
Positives
Rocky Creek
156
901
335
70
265
20.8
Agricola
129
527
307
73
234
23.7
Broom
60
284
144
75
69
52
Central
76
398
93
28
65
30
Basin
50
197
100
32
68
32
Bexley
37
190
70
44
26
66.6
Salem
20
100
43
18
25
41.8
W ard
50
34
13
21
41
Howell
25
11
3
8
27.3
Lucedale
400
182
49
183
26.9
Office
260
260
55
205
21.1
Lucedale (Col.) 60
290
130
6
124
4.8
Summary and Conclusion
part
ment staff to
concentrate on
this goal. It
A hookworm survey v/as made of George
County during 1944-1945, working through the
schools. It was demonstrated that 19.5 per
cent of the white adults and 31.7 per cent of
the white children had hookworm infection.
The reduction in the incidence of hookworm
infection from 1910-1914 to 1944-1945 was
64.6 per cent; from 1932-1933 to 1944-1945,
28.7 per cent.
The age group 10-14 had the highest rate of
infection.
It was revealed that 48.1 per cent of the
families had one or more infected members;
78 per cent of the infected individuals came
from one-fourth of the total families tested.
The Negro population had an infection rate
of 4.8 per cent in a small number tested in
the Lucedale area.
Low economic status and its resultant poor
environmental conditions seems to be in some
measure responsible for the higher incidence
of hookworm in certain areas of the county.
In spite of the good work which has been
is further recommended that measures such
as the following be included in the program.
1. All school children be tested for hook-
worm infection prior to admission to
school each fall.
2. All positive pupils be treated until free
of hookworm.
3. Adults be encouraged to have tests made.
4. Effective education about hookworm dis-
ease be extended to everyone.
5. Construction and use of sanitary privies
be encouraged in areas where needed.
6. Research be undertaken with a view to-
ward developing new and better methods
of treatment and prevention of hookworm
infection.
When such measures as these are instituted
and carried out, it is earnestly believed that
the incidence of hookworm disease can be al-
most, if not wholly, eradicated within a few
years.
REFERENCES
done toward the eradication of hookworm in-
fection, it may be readily seen that its incidence
is much too high for the county in which this
survey was undertaken. The same no doubt
holds true for other areas. It is apparent that
the program must be expanded in order to
attack the problem with new and increased
vigor to insure certain and lasting results. It
is recommended that well-trained public health
workers specializing in health education and
hookworm control be added to the health de-
1. The Rockefeller Sanitary Commission for the
Eradication of Hookworm Disease. Annual Reports,
1910-1914.
2. Keller, A. E., Leathers, W. S., and Ricks, H. C.:
An investigation of the incidence and intensity of
infestation of hookworm in Mississippi. Amer.
Jour. Hyg. 19: 629-656, May, 1934.
3. Nickel, N. S. : Amebiasis and hookworm infection
as found in approximately 50,000 fecal examina-
tions in Mississippi. Amer. Jour. Trop. Med. 22:-
209-215, 1942.
4. Keller, A. E., Leathers, W. S. and Denson, Paul
M. : Results of recent studies of hookworm in
fight Southern States. Amer. Jour. Trop. Med.
20: 493-509, July 1940.
He most prevails who nobly dares.
— William Broome
August, 1945
Woman’s Auxiliary
413
PREVALENCE OF COMMUNICABLE
DISEASES IN MISSISSIPPI
May
May
May- 5
1945
1944
yr. avg.
Acute poliomyelitis
2
6
3.4
Bacillary dysentery
964
1034
1289.6
Dengue
0
0
2.6
Diphtheria
19
24
18.2
Influenza
1631
1717
1595.6
Measles
2418
2133
2233.6
Meningococcus meningitis
9
30
18.4
Other forms meningitis
2
9
4.0
Pellagra
169
286
305.0
Pneumonia
918
842
760.4
Pulmonary tuberculosis
1189
152
146.6
Scarlet fever
47
20
22.6
Smallpox
0
3
3.2
Tularemia.
2
19
6.6
Typhoid fever
7
10
8.6
Typhus fever
9
10
5.4
LJndulant fever
2
5
2.8
Whooping cough
838
1514
1319.2
June
June
June 5-
June
June
Yr. Avg.
Acute Poliomyelitis
3
10
6.8
Bacillary Dysentery
1692
2365
2601.4
Dengue
0
0
.8
Diphtheria
27
16
16.2
Influenza
1032
935
949.2
Measles
1237
671
957.8
Meningococcus Meningitis
12
15
10.6
Other Forms Meningitis
2
1
1.6
Pellagra
239
267
332.4
Pneumonia
591
484
456.8
Pulmonary Tuberculosis
145
241
154.6
Scarlet Fever
30
19
18.8
Smallpox
0
5
1.6
Tularemia
5
18
9.4
Typhoid Fever
14
13
17.8
Typhus Fever
12
25
12.2
Undulant Fever-
8
3
5.6
Whooping Cough
820
1495
1222.0
I really think that next to the consciousness
of doing a good action,
that of doing a civil
one is the most pleasing :
and the epithet which
I should covet the most,
next to that
of Aris-
tides, would be that of “well-bred.”
— Lord Chesterfield (1594-1773)
45 • * * * *
Labor to keep in your breast that little
park of celestial fire called conscience.
— George Washington
Womans Auxiliary
President
Vicksburg
. . Mrs. L. J. Clark
President-Elect
Corinth
. . Mrs. Stanley Hill
First Vice-President
Jackson
Second Vice-President ........
Sanatorium
Mrs. Henry Boswell
Third Vice-President
Booneville
Recording Secretary
Jackson
Mrs. Geo. W. Owens
Fourth Vice-President
Jackson .
Treasurer
Cleveland
Mrs. J. D. Simmons
Historian
. Jackson
Dear Auxiliary Members:
Now is the time to make your plans for
your Auxiliary activities for the year. Don’t
wait until the first meeting to appoint chair-
men, formulate your plans, and outline pro-
grams. Let’s be ready to start off with a bang
at the first signal.
It will be my pleasure to serve you again
as your president, and with the experience of
the past year, I shall be able to help more
efficiently and successfully. The task seems
hard but with your loyalty, support, and in-
terest I shall strive diligently to achieve some
of the aims and objectives that are ours as
auxiliary members
We missed our annual convention this year
but the executive board met and was well
attended, which was very gratifying to your
president.
Reports showed that we had made pro-
gress during the trying times and your officers,
chairmen, and councilors felt that the meeting
had proved of great benefit and they returned
home to work with renewed interest and en-
thusiasm.
The fall executive board meeting will
come early this year and I trust it will be
well attended. This friendly contact of the
executive committee should be inspirational as
well as helpful in making plans and exchang-
ing ideas. Each should go back to her district
with renewed determination and enthusiasm
to make a better auxiliary member.
Affectionately,
ANNE CLARK, President
The Mississippi Doctor
August, 1945
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Marion Sims and Other Nineteenth Century Pioneers:
the Dawn of Scientific Medicine and Surgery
SEALE HARRIS, M.D.
Birmingham,
PARZ II
Marion Sims was established as a surgeon
in Paris in 1862. It is safe to say that he
was keenly interested in Pasteur's- achieve-
ments, and no doubt he was on the side of
Pasteur in his controversy with the eloquent
Ponchet. Sims was one of the first great sur-
geons of the time to accept Pasteur’s germ
Jieory of disease.
Statue of Marion Sims
Montgomery, Alabama
Anthrax in sheep was an important economic
problem in France, which Pasteur solved by
producing immunity to the disease in cattle
with the use of attenuated cultures of the an-
thrax bacillus. While Pasteur was making ex-
periments on anthrax, a few sheep died. The
antivivisectionists of France arrayed against
Pasteur, and for a time many sheep raisers
regarded him as they did a “sheep-killing dog.”
Alabama
proof that his vaccines would prevent the
disease in sheep. In their presence he gave
twenty-five sheep the vaccines, and a few
weeks later- he innoculated them and twenty-
five other sheep with cultures of the anthrax
bacillus. They were invited back later to find
the twenty^five sheep grazing contentedly
while the twenty-five unvaccinated sheep were
all dead. Howard W. Haggard, in Devils, Drugs
and Doctors, cites Huxley, the English biol-
ogist, as estimating that the economic saving
to France by Pasteur in his discoveries of
methods for preventing diseases of wine, silk-
worms and sheep “would suffice to cover the
indemnity of five billion francs paid by France
to Germany in 1870.”
Hydrophobia, the most fatal of all diseases,
at one time threatened to destroy all the dogs
in France ; and hydrophobia was not infrequent
among the human victims of mad dogs. Pas-
teur, in attacking that problem, was unable
to isolate the micro-organism that caused hy-
drophobia—it has not yet been found — but
he made a culture of it and called it a virus.
He found that the virus of rabies was fixed
in the nervous system of dogs. He reproduced
the disease in rabbits, and by using attenuated
cultures made from the nerve tissue of rab-
bits, produced immunity to rabies in dogs and
hydrophobia in human beings. Since the incuba-
tion period of rabies is longer than the time that
it takes to produce immunity, Pasteur’s rabies
vaccine if used early enough will prevent the
disease in animals and in human beings who
have been bitten by mad dogs.
While rabies is found occasionally in cats
and among wild animals, if it were possible
to vaccinate the canine population of a coun-
try against the disease, as is practiced on
persons in the United States in the prevention
of typhoid fever, there would be no more mad
dogs and hydrophobia would cease to exist.
It is strange that the French failed to recog-
nize the import of Pasteur’s discoveries until
after Joseph Lister of Glasgow, in 1866, had
applied his principles in developing antisepsis
in preventing the infections of wounds; and
until the Germans, after 1880, working on his
germ theory of disease, though giving Pasteur
One of Pasteur’s great triumphs in confound-
ing his critics was to invite them to witness
4UBRARY - UNIVERSITY OF MARYLMfi
416
Marion Sims — Harris
September, 1945-
scant credit for the greatest of all achieve-
ments in medicine — had evolved the science of
bacteriology. It was not until 1886 that the
Pasteur Institute was established to put into
practice Pasteur’s method of vaccination
against hydrophobia. It later was enlarged and
endowed, until it became recognized as one
of the greatest research institutions in the
world. The French government also awarded
him the Grand Cross of the Legion of Honor,
and provided him a comfortable annuity to
care for him in his declining years. The French,
though belated in recognizing the greatness of
Pasteur, revered him in the latter years of
his life for what he had done for France. How-
ever, the thought comes that if the French
had loved Napoleon, and his imperialism, less;
and had appreciated Pasteur, and his ideals,
more, their place in the world would be dif-
ferent from what it is today.
Lister. Joseph Lister (1827-1912) was the
greatest Englishman, or Britisher, who has
lived; and he is second only to Pasteur as a
benefactor of mankind. He was born of Quaker
parentage near, and educated in, London. After
graduation in medicine in 1852 he was an as^
sistant for five years to James Syme, pro-
fessor of surgery in the University of Edin-
burgh. Lister’s greatest accomplishment in Ed-
inburgh was to marry Agnes Syme, the beauti-
ful and accomplished daughter of the great
Scotch surgeon in 1856. He was made professor
of surgery in the University of Glasgow in
1860. There he continued the study of healing
in wounds begun in Edinburgh.
Lister was appalled at the high mortality in
the surgical wards of the Royal Infirmary of
Glasgow. They were not higher there, how-
ever, than in any other hospital in the world
of that time. Lister reported a death rate of
forty-five per cent in his own amputations in
1864. In studying the causes of infections, in
practically all operations he was convinced that
lack of cleanliness of the hospital was one
factor. He observed that simple fractures in
which there were no open wounds usually
healed without any trouble ; while patients
who had compound fractures in which there
was an open wound usually developed gan-
grene or septicemia and died. He concluded that
something from the air infected the open
wound.
In 1864 Lister’s friend, Thomas Anderson,
professor of chemistry in the University of
Glasgow, suggested that he read Pasteur’s ad-
dress delivered before the French Academy of
Sciences in Paris in 1862, in which he reported,
his researches on fermentation and putrefac-
tion. Lister, on reading Pasteur’s proof that
microbes from the air caused fermentation
of wine and the putrefaction of meats, con-
cluded that if he could exclude micro-organ-
isms in the air from clean wounds, they would
heal without inflammation.
With this idea dominant in his mind Lister
went to work to develop methods to prevent
the entrance of germs into wounds. Carbolic
acid was known to be a deodorizer and Lister
surmized that it would kill micro-organisms
that he believed were the cause of inflamma-
tion, gangrene and septicemia. He used a five
per cent solution to disinfect his surgical in-
struments and his hands before operations,
and the same solution to disinfect his surgical
instruments and his hands before operations,
and the same solution to disinfect the skin in
clean operations and open wounds in ac-
cidents. Following the operation he covered
the wound with six layers of gauze that had
been soaked in the carbolic acid solution to
prevent the entrance of germs. He tried that
method in his surgical wards of the Royal In-
firmary with the result that in a few months
in eleven cases of compound fractures there
were ten recoveries and only one death.
Lister’s first article on his antiseptic tech-
nique “On Compound Fractures,” appeared in
the London Lancet in March 1867. Another fol-
lowed on “Preliminary Notice on Abscess,”
and finally his address before the British Medi-
cal Association in Dublin, entitled “On the
Antiseptic Principle in the Practice of Surgery,”
was published in the same journal. In the last
he summarized his results, including a state-
ment that in nine months, in all kinds of opera-
tions, not a case of pyemia or hospital gangrene
had occurred. In this immortal paper Lister-
proved beyond the shadow of a doubt that the
use of his antiseptic methods would prevent in-
fections in clean surgical operations. Any sur-
geon with an open mind would have adopted
methods which should save the lives of his
patients. Lister had revolutionized the practice
of surgery; but few then established surgeons
would admit it.
Following the publication of Lister’s article,,
a flood of papers were published in the medi-
cal journals of England, Scotland and Ireland
attacking Lister and his methods. Among the-
October, 1945
bitterest antagonists of Lister was Sir; James
Simpson, who had silenced his critics, on the
use of chloroform in midwifery; but who 'tfras
vanquished by Lister in reply to articles in
which Simpson questioned his veracity. Sir
James derided as ‘‘mythical fungi” the micro-
organisms described by Pasteur as being the
cause of fermentation and putrefaction, and on
which Lister based his ‘‘antiseptic principle”
in surgery. Sir James Simpson was a tradition-
al adversary of James Syme’s, and his mind was
closed to anything worthwhile that the son-in-
law, Joseph Lister, could do. Syme defended
Lister, and accused Simpson and others of an
attempt to “filch away the credit due him”
(Lister).
Marlon Sims was one of the first great
surgeons to adopt Lister’s antiseptic technique.
He no doubt was a believer in Pasteur’s theory
of micro-organisms as the cause of fermenta-
tion and putrefaction before Lister had read
Pasteur’s article on that subject. Sims was
president of the American Medical Association
when Lister came to the United States to at-
tend the International Congress of Surgery,
held at the Centennial Exhibition at Philadel-
phia in 1876, and was one of his hosts while
in New York. Up to that time there were few
American surgeons who used, or believed in,
Lister’s methods. Lister’s tour of the United
States and Canada, when he visited Boston,
New York, Philadelphia, Salt Lake City and
San Francisco, Toronto and Montreal, stimu-
lated an interest in antisepsis in surgery; and
he convinced many of the leading surgeons
in America of the value of his method. There
were many skeptics, however, whom he did
not conyince, as shown by the fact that at a
meeting of the American Surgical Association
in 1883, most of the speakers opposed the Lis-
cerian theory. / . ,, .
In October 1877, Sims, theriMn Paris on a
visit, published a letter in the British Medical
Journal, commenting on Lister’s first address
as professor of surgery in King’s -College, Lon-
don. Excerpts from that letter showHhat Sims
visualized asepsis in surgerytyears before the
German^ proved its value, Sims said:
"... . '?
“For a long time, I have been fully eon-
vinced of the value of antisepticism in
surgery. It is certainly, /oA&L'of the great
advances, if not the' greatest,' of the age*;
Marion Sims— Harris • 417
... J " ■ - -A*. ■■
and I am surprised that the profession
has been slow in adopting it. ... ... . For my-
self, I accept Professor Lister’s theories
v; out and out. His results, whether his
theory is true or false, are all that he
claims and all that could be desired.
Why, then, I repeat, are we so slow to
adopt his method? The objections that I
have heard urged against it are these:
1. It takes too much time; 2. It is too
complex; 3. It is too expensive. Now, I
would most respectfully ask Professor
Lister, ‘Is it not possible to simplify the
dressing, so as to do away with all these
objections and at the same time insure
the same successful results?’ Seven years
ago, it was my great privilege to spend a
whole day enjoying the hospitality of my
friend, Professor Lister. By reading his
philosophic papers before my visit, I was
fully convinced of the truth of his theo-
ries; and by witnessing the results of his
practice, I was equally convinced of the
value of his method. At that time, it oc-
curred to me to ask the question above
propounded; but I could not, and did not.
I was prompted to it by seeing in his
laboratory a score or more of flasks with
long necks, stoppered only with a clean
cotton wool, each flask containing urine,,
or other putrescible fluids, which have all
remained unchanged, some for months and
some for years. These curious experiments
embody a great truth which Lister has for
long years implored us to accept and put
to practice, but we do not . . .
“Now, if putrescible fluids in a flask
can be thus so easily protected against pu-
" trefaction simply with a bit of clean cotton
wool, without adding layers of carbolized
cloth, why cannot wounds that might take
on putrefactive action be protected against
this just as thoroughly with a simple
covering of clean cotton wool, without
these, expensive carbolized coverings? . . .
For the last ten years, I have used plain
clean dry chtton wool as a dressing for
the abdominal section in ovariotomy, and
I can truly say that no other dressing can
compare with it. To vkill atmospheric or-
ganisms in a glass flask with a long nar-
row neck-,- we apply ^ nothing else, and it
prdtects the contained fluid against all
change 'indefinitely. About this there is
. -la
)U
Marion Sims — Harris
418
not the shadow of a doubt. And to kill
atmospheric organisms during surgical
operations, we use carbolic acid, dilute sul-
phurous acid, or other-germicide, in spray,
and with absolute success. "Now, if at this
stage of the operation we could simply
cover the wound over with cotton wool,
as we do the mouth of the purified flask
which contains putrescible fluids, it would
save us a great deal of time, trouble and
money. If the cotton wool ‘does not per-
mit the entrance either of the yeast-plant
or any other form of dust’ in the one in-
stance, why should it in the other? If the
cotton wool filters the-airlrom its impuri-
ties as it passes thmugh-^asglass tube, why
can it not do the same thing under other
and all circumstances? ... It is, there-
fore, important that something be done
not only to simplify the- dressing, but to
cheapen it, before it can be generally
adopted in hospital practice; and I know
of no one so competent to do this as
Professor Lister, the, father of antiseptic
surgery. He has made many modifications
of his method since he first published it
to the world. Let him_go on till he re-
duces it to that degree of simplicity and
perfection that will compel every one to
adopt it.”
It is of passing interest to note that the
simplification of surgical dressings by the use
of a layer of cotton over the site of operations
was practiced by Sims for a quarter of a cen-
tury before asepsis, instead of antisepsis, was
generally adopted by the best surgeons.
The leading surgeons of London were the
last to accept Lister’s theories and to adopt
his methods. They rose up in arms and pro-
tested when it was announced that he had
been invited to become professor of surgery
in King’s College ; but Lister, anxious to prove
to his fellow countrymen the value of antisep-
sis in surgery, accepted the position. A majori-
ty of the faculty of King’s College lined up
against Lister. They were so hostile to him
that, according to Rhoda Truax, Lister’s latest
and best biographer, in “Joseph Lister, Father
of Modern Surgery,” “a student had to care
a great deal about pure knowledge to jeopard-
ize his chances of getting a degree by listening
to what Mr. Lister had to say.” Lister soon
won over the students, as he had done the
young men in Glasgow and Edinburgh. He said:
September, 1945
“From the beginning I had youth on my side.”
-Every possible obstacle was placed in the
way of the new professor of surgery to prevent
his views from prevailing. He was laughed at
by his erudite confreres; and his “donkey”
engine, which generated steam to spray a so-
lution of carbolic acid over the site of opera-
tions was the joke of London. Lister worked
quietly and patiently. He proved his low mor-
tality rates, as compared to those of Wood and
his other critics in the same hospital, that his
antisepsis in surgery would save human lives.
Lister’s triumph in London was complete.
He became the leading surgeon of the British
metropolis. He was called upon to operate upon
Queen Victoria, whose life was threatened by a
large abscess. In this operation he used his
antiseptic methods, including the derided “don-
key” engine. The operation was entirely suc-
cessful and in thanking her surgeon Queen
Victoria said it was “a most disagreeable duty
most agreeably performed.” In her gratitude
Queen Victoria made Lister her “Surgeon in
Ordinary” in 1878. In 1883 the Queen bestowed
upon him the highest honor that had ever been
given a physician when she made him a baron-
et. In 1885 Lord Lister was awarded honorary
degrees in Oxford and Cambridge. He also was
given the Prussian Order of Merit in the same
year.
The “donkey engine” Lister used to generate
carbolized steam to destroy germs in operat-
ing rooms, was discarded by him in 1887, be-
cause as he admitted “it was valueless.” Like-
wise he abandoned the use of the odoriferous,
cumbersome, carbolized muslin dressings to
substitute for them a layer of sterilized cotton
to protect wounds from invasion by pyogenic
bacteria. Lister, himself, in the latter years
of his practice, adopted the aseptic technique
developed by the Germans; but he established
a principle, which when applied by careful
surgeons, has enabled them to invade the ab-
dominal cavity, the lungs, the brain and every
other organ of the body, when necessary to
remove diseased tissue. Surgeons will be sav-
ing human lives until the end of time because
Joseph Lister had the vision to see the rela-
tionship between pathogenic micro-organisms
and inflammation, gangrene and erysipelas;
and because he developed methods of prevent-
ing the invasion of open wounds by pathogenic
germs.
Before Lister died in 1912, at the age of
eighty-five years, he knew that his principle
September, 1945
Marion Sims— <Rarris
419
of protecting wounds from invasion was
adopted in every country in the world in which
scientific surgery is practiced. There were a
few surgeons in Edinburgh and London who
never forgave Lister for his greatness, and
who could not forget that in their efforts to
discredit him they exhibited their own weak-
ness; but he died the best beloved man in the
British Empire, and his body is interred in
Westminister Abbey, with other immortal
Englishmen. So long as medical history is
preserved Joseph Lister will be known as the
greatest surgeon of all time.
Bobert Koch. In 1870 Robert Koch (1843-
1910), at the age 27, served as a medical offi-
cer of the German army in the Franco-Prus-
sian War. Marion Sims, at the age of 57, a
colonel in tihe French army, operated on
French and German soldiers wounded in the
battle of Sedan. Sims had never heard of
Koch, who was marked by destiny to develop
the science of bacteriology, but every doctor
serving in the German army had heard of Sims.
The German government had bestowed the Iron
Cross — then an insignia of honor — upon Sims;
and he had been given honorary membership
in a number of German medical societies.
Operations devised by Sims had been per-
formed by a number of leading German sur-
geons, some of whom failed to give an Ameri-
can credit for having perfected a procedure
which enabled them to cure women of a hope-
less condition that sometimes followed pro-
longed labor. Sims’ book, Uterine Surgery,
published simultaneously in Berlin, London and
New York in 1865, was revolutionizing the
treatment of diseases of women in Germany;
his speculum, and other instruments he had
devised, were being used by German surgeons —
with mentioning that they were the product
of his ingenuity. In later years the Germans
claimed that gynecology originated in Ger-
many.
Two years after the Franco-Prussian War
had ended Koch’s wife made him a birthday
present of a microscope. He was then a coun-
try doctor in Silesia, in which sheep raising
was the principle source of income for peas-
ants, some of whom were patients of Koch.
Knowing of Pasteur’s germ theory of disease,
Koch’s first use of his microscope was in try-
ing to find the micro-organism that causes
anthrax in sheep. He succeeded in 1876, and
that achievement was the beginning of the
science of bacteriology.
Koch found that the anthrax bacillus could
be stained with analine dyes, and that it could
be cultured on gelatin, a solid medium. He in-
oculated sheep and rabbits with culture of an-
thrax. He made cultures of bacillus anthracis
obtained from the animals he had inoculated
and injected them into rabbits, causing an-
thrax in them. The publication of this work was
responsible for Koch’s being invited to Berlin,
where with ample laboratory facilities and
capable assistants he continued his studies on
bacteria. Using a Zeiss oil immersion lens
and an Abbe condenser on his microscope, and
with the use of analine dyes in staining bac-
teria, Koch discovered the bacillus of tubercu-
losis in 1882, and the bacillus of cholera in
1884.
Asepsis. Koch’s bacterial studies provided the
basis for developing asepsis in surgery. He and
Klebs found streptococci and staphylococci in
the pus of infected wounds. Koch and Fehleisen
proved that streptococci cause erysipelas. Koch
studied the effect of antiseptics on streptococci
and staphylococci, and proved that a 1-1000
solution of bichloride of mercury was- more ef-
fective in destroying them than a five per cent
solution of carbolic acid. Koch also proved that
the use of boiling water and steam was the
best method of sterilizing instruments and
gauze before operations.
While Koch and his confreres in Berlin were
experimenting with pyogenic bacteria and
methods to prevent infection of wounds, a
Swiss professor of bacteriology in Zurich, Carl
Eberth, discoverer of the bacillus typhosus,
made studies of bacteria on the hands. He
found streptococci and staphylococci and other
micro-organisms on the surface of the skin,
beneath finger nails and in hair follicles.
Eberth proved that immersion of the hands
in solutions of carbolic acid and bichloride of
mercury did not sterilize them, but that scrub-
bing them with soap and a nail brush and
thorough cleansing in running water was more
effective.
When Lister’s paper on the antiseptic prin-
ciple was published in 1866 it started a con-
troversy that lasted a quarter of a century
between Theodor Billroth, professor of surgery
in the University of Vienna, then the greatest
teaching medical center in Europe; and von
Bergmann, professor of surgery in Berlin,,
which following the epoch making achieve-
ments of Virchow was the first medical rival
of the Austrian capital.
420
Marion Sims — (Harris
October, 1945
Billroth, working in the Algemeines Krank-
enhaus in Vienna, then the greatest teaching
hospital in the world, combated Lister’s the-
ories with all the fervor of a reactionary fight-
ing to prevent progress. He refused to use Lis-
ter’s methods; and the mortality records of
deaths from septicemia, gangrene and ery-
sipelas remained high in Vienna hospitals. In
Germany von Bergmann in Berlin, Thiersch in
Leipzig, von Volkmann in Halle, and von Nuss-
baum in Munich, applied Lister’s antisepsis
methods in the surgical wards of their hos-
pitals, with amazing reductions in the number
of deaths from wound infections. Von Berg-
mann found Lister’s methods difficult in ap-
plication and he determined to develop a
technique which would eliminate the use of
carbolic solutions. Applying the knowledge
learned from the researches of Koch, Klebs and
Eberth, von Bergmann and his assistant, Carl
Schimmelbusch, developed the aseptic tech-
nique in surgery as it is practiced in every
well equipped hospital in the world today. The
publication of Schimmelbusch’s book on “The
Aseptic Treatment of Wounds” in 1892 had
a profound effect in the transition from anti-
sepsis in surgery. It brought surgical asepsis
to the United States the same year.
The Advent of Johns Hopkins Medical School.
W. S. Halsted, professor of surgery in the re-
cently established Johns Hopkins Medical
School, on reading of the technique employed
in von Bergmann’s clinic in Berlin, had steam
sterilizers placed in the operating rooms of
the Johns Hopkins Hospital. Halsted, and his
associate, Howard A. Kelly, professor of
gynecology, abandoned Lister’s methods and
adopted the von Bergmann aseptic technique
in every detail. Three ' years later in 1875,
Hunter Robb, an associate of Kelly, published
a book describing the aseptic technique in use
at Johns Hopkins Hospital as adapted from
methods employed by von Bergmann and
Schimmelbusch. In the same year Welch pub-
lished The Bacteriology of Surgical Infections.
These books were factors in popularizing asep-
tic surgery in the United States.
The use of rubber gloves was an important
development in aseptic surgery. When first
used at the Johns Hopkins Hospital in 1888,
their effect in preventing the transmission of
pathogenic bacteria from the surgeon’s hands
to open wounds was not considered. The late
J. M. T. Finney, in his autobiography, A Sur-
geon’s Life , related an interesting romance of
how rubber gloves were first used in operating
rooms. Finney said:
“The story of the development of the
use of rubber gloves in surgery is a curious
one. In addition to her unusual profession-
al qualifications, the head nurse in the
Johns Hopkins Hospital operating room,
Miss Caroline Hampton, had for some time
attracted the personal interest of Dr. Hal-
sted, who was a bachelor. This mutual at-
traction had early been observed by the
members of the resident staff and the
operating room nurses, and, needless to
say, the progress of the courtship was
watched with interest. About this time
Miss Hampton’s hands, which had suffered
greatly from immersion in the antiseptic
fluids, carbolic acid and bichloride of mer-
cury, had reached the point where she
could no longer carry on. Dr. Halsted’s
concern for Miss Hampton was two -fold;
an interest in her personal well-being and
in having her assistance in carrying out
the operating room technique. After trying
various experiments to no avail, he final-
ly hit upon the idea of having made for
her thin rubber gloves, which would afford
the desired protection to the skin of her
hands . . .
“One day in discussing the use of rubber
gloves for Miss Hampton, Dr. Bloodgood
observed that ,‘what’s sauce for the goose
is sauce for the gander.’ If rubber gloves
were all right for the nurse’s hands, why
not put them on the surgeon and the other
assistants? The idea took, the gloves were
made and gradually came into use, first
by the nurse, then by the assistants and
finally by the operator himself. From that
time on rubber gloves have been in con-
stant use not only in the surgical clinic
of the Johns Hopkins Hospital but in
modern, up-to-date hospitals, all over the
world ... It is a pleasure to note that the
interesting romance begun in the operating
room, yielded a priceless boon to aseptic
surgery, and finally culminated in a happy
marriage.”
Since the complete moral and physical deg-
radation of Germany as a nation, it is not
popular to credit the Germans with having
accomplished anything good at any time; but,
the fact remains that the development of scien-
October, 1945
Marion Sims — 'Harris
421
tific medicine and surgery in the last half of
the nineteenth century was largely the pro-
duct of German brains and ingenuity. This is
said without discredit to Bichat, Pasteur, Lis-
ter, and other pioneers in medicine and sur-
gery, who discovered the principles upon which
the Germans based their epoch-making studies
in pathology and bacteriology. No one can
deny that the Germans are largely responsible
for making the laboratory a sine qua non in the
practice of medicine and surgery.
Ii a student of medical history were asked
to name the four physicians who did most to
advance the science and practice of medicine
and surgery in the last fifteen years of the
nineteenth century, without hesitation, he
would list four professors^ in the Johns Hop-
kins Medical School, i.e., William H. Welch
(1850-1934); William S. Halsted (1852-1933);
William Osier (1849-1919) and Howard A.
Kelly (1858-1944). The four men after having
received the best possible training in medicine
in America — Welch at Yale; Halsted at Colum-
bia; Osier at McGill; and Kelly at Pennsyl-
vania— spent several years in postgraduate
study in Europe, largely in Germany. Welch
and Halsted in New York, Osier and Kelly
in Philadelphia, brought to the United States
laboratory methods they had learned in Ger-
many. The equipment and supplies for their
laboratories were purchased largely in Ger-
many.
In 1886, when William H. Welch was selected
by Daniel Gillman, president of Johns Hopkins
University, to develop Johns Hopkins Hospital
and Johns Hopkins Medical School, he brought
Halsted as professor of medicine and Kelly
as professor of gynecology. Welch himself be-
came professor of pathology. Halsted was first
a pathologist ; Osier had been professor of
pathology in the University of Pennsylvania;
and Kelly had excellent training in pathology.
Those four men applied in Baltimore the path-
ology and bacteriology they had- learned in
Germany. Each of them made important con-
tributions in their respective fields; and what
is perhaps more important, they published re-
ports of their achievements in many books and
hundreds of articles in medical journals.
Welch discovered the bacillus of gas gan-
grene. Among the publications of Welch, which
had a profound influence on medical thought
in the United States and Canada, were “General
Pathology of Fever,” 1888 and “The Biology of
Bacterial Infection and Immunity” in 1894.
Halsted’ s leadership in scientific surgery
was established by his introduction of the asep-
tic technique in surgery, by his using cocaine
in nerve blocking; by his operation for hernia
and his radial operation for cancer of the
breast; and his experimental work in goitre.
Osier did not make important discoveries
in medicine, but he was among the first to
stress the relationship of pathology and bac-
teriology to practical medicine. Osier’s Practice
of Medicine, first published in 1892, was an
important factor in raising medicine from the
slough of empiricism, into which it had fallen,
to a science. Edith Gettings Reid, one of Os-
ier’s best biographers, said of Osier’s text
book: “A wonderful book. Indirectly it created
the Rockefeller Institute for it caught Mr.
Rockefeller, (Jr.) by its lucidity.” Cushing
said: “It [Osier’s Practice of Medicine ] con-
tributed to the incalculable benefit of humani-
ty which the General Education Board has
rendered with Mr. Rockefeller’s money, owing
to its interest in the prevention and cure of
disease. Indeed the present position of his col-
league, Welch, as director of the Institute of
Hygiene, is remotely due to the fact Osier set
himself thirty years before to write a text book
of medicine.”
Sir William Osier, later regius professor of
medicine at Oxford, did more to advance and
popularize medical science in English speaking
countries than any man who has lived.
Kelly developed scientific gynecology far
beyond the stage that Sims left it when he
died in 1883, and advanced it farther than
Sims’ proteges, Emmett, Gaillard, Thomas and
others had done. Kelly made Johns Hopkins,
and his own private hospital in Baltimore, the
mecca — as the Woman’s Hospital in New York
had been — to which surgeons interested in the
surgery' of women flocked, to learn the best
of everything in gynecology. Kelly "devised
many new instruments, including those for
cystoscopy and the diagnosis and treatment
of disorders of the ureters and pelvis of the
kidney. Kelly’s books — illustrated by Max
Broedel, whom he brought from Germany to
Johns Hopkins — Operative Gynecology in 1898,
Medical Gynecology in 1912, and Gynecology in
1928, are the greatest contributions to the
literature on scientific gynecology that have
been published.
At the end of the nineteenth century, “the
big four,” Welch, Halsted, Osier, and Kelly,
were without peers as champions of scientific
422
Marion Sims — (Harris
September, 194&
medicine and surgery; and the Johns Hopkins
Medical School had assumed the leadership
in medical education in the United States.
Baltimore, however, was not the only city in
which great progress was made in the advance-
ment of all branches of medicine. Early in the
twentieth century, the faculties of Harvard,
Yale, Columbia, Cornell, Pennsylvania, Mich-
igan, Washington (in St. Louis) and other then
leading medical schools, adopted German meth-
ods of asepsis and developed their laboratories
until they were as good, or better, than those
at Johns Hopkins. A great medical center, the
Mayo Clinic, was developed in a Minnesota
small town. Rochester, Minnesota, became a
medical centre for ambitious surgeons who de-
sired to learn the latest methods in surgery
and medicine.
Germany lost her leadership in medicine
when she followed the ignis fatuus of world
domination in World War I; and as far as
the science of medicine is concerned, she was
made totally bankrupt by the Hitler dynasty.
The United States is far in the lead of any,
and all, other nations in scientific medicine
and surgery in the middle of the twentieth
century.
We are living in the Golden Age of medicine,
made possible by the vision and courage of
pioneers in the last half of the nineteenth
century. Miracles after miracles have been
wrought by many scientists in many research
laboratories in the last four and a half decades.
The science of nutrition, including the discovery
of vitamins, developed largely in the United
States, is of far-reaching import in the up-
building of mankind. Public hygiene, beginning
with the sanitation of Cuba and Panama Canal
Zone from 1900 to 1910 by William Crawford
Gorgas (1854-1920) ; and extended by the de-
velopment of state departments of health, with
health units in every city and county in our
nation, is eradicating the contagious and com-
municable diseases from the confines of the
United States. American methods of public
health administration are being adopted by
other nations, particularly in Central and South
America, to the betterment of many million
people. The saving of human lives is of greater
importance than curing the sick, and that
American viewpoint is being adopted by all
nations.
Among the most important of the miracles
of the twentieth century are the insulin treat-
ment of diabetes, discovered by Banting and
Best at the University of Toronto in 1921;
liver therapy in pernicious anemia and avitami-
nosis by Minot and Murphy at Harvard Univer-
sity in 1926; the sulfa drugs (chemotherapy),
partly of German origin, but developed largely
in the United States, in the treatment of pneu-
monia, meningitis, septicaemia, and many other
infections; and penicillin, which not only is
displacing the sulfa drugs in dramatic cures of
pneumonia, meningitis, septicaemia, and all
pyogenic infections, but is curing syphilis and
gonorrhoea in an incredibly short time. The
discovery of penicillin should be credited to
Sir Alexander Fleming of Oxford University,
England; but methods for the manufacture
and distribution of penicillin on a large scale
were worked out largely in laboratories 3 in
Canada and the United States. Miracles in ab-
dominal surgery, neuro-surgery, chest surgery,
bone and joint surgery, gynecology, and other
surgical specialties are being performed in
thousands of operating rooms all over the
world because Pasteur, Lister, Koch, and von
Bergmann discovered and applied the principles
of antisepsis and asepsis in the last half of the
nineteenth century. Verily, it is a glorious
privilege to live and to practice scientific medi-
cine and surgery in this Golden Age.
Decentralization in Medicine. About Novem-
ber 15, 1918, at a small dinner party in Paris,
Colonel George Crile, a great American sur-
geon, who served with distinction in the Ameri-
can Expeditionary Forces in France, was asked
what influence on medical and surgical prac-
tice would follow American participation in
World War I. He said to an associate by his
side, Brigadier-General J. M. T. Finney, chief
of surgical consultants: “Finney, I have seen
in many operating rooms in Army hospitals in
France many surgeons whose names I did not
know, from towns in the United States that I
never before heard of, doing as good surgery
as you and I are capable of doing. Those men
have learned the advantages of group practice
and when they return home, they will es-
tablish hospitals and small clinics to care for
medical and surgical cases in their communi-
ties. We shall see the decentralization of medi-
cine follow this war.”
That Crile was a prophet has been proved
by the fact that in the last twenty-five years
small hospitals and clinics have been estab-
lished in a large proportion of towns of over a
thousand population in the United States. In
.September, 1945
Marion Sims — Harris
423
many of those hospitals aseptic surgery and
scientific medicine are practiced by capable
surgeons and clinicians. While the great medi-
cal centres are thriving, so are the small hos-
pitals. It is a significant fact that in the year
1945, there are few outstanding surgeons and
medical cliniciariS-; but the average of effi-
ciency in medical practice has been raised, un-
til there is little reaSbh for the average medical
and surgical patients- to leave their home com-
munities for treatment. There will always be
difficult Cases requiring the service of special-
ists^ with large experience in their respective
fields," but the decentralization of medicine will
continue. It certainly is true that the citizens
of the United States are being cared for when
they are sick better and more efficiently than
ever before in our history; and in no other
country in the world have such advances been
made in scientific medicine and surgery.
The altruism of the medical profession has
been proved by the fact that American physi-
cians— I believe without exception — have par-
ticipated in every movement directed toward
the prevention of disease. All that has been
accomplished in the prevention and cure of
disease has been due to the initiative and de-
votion to duty of individual physicians, who
have been unhampered by government direc-
tion. The movement on foot by socialistic
theorists, labor unions, and vote seeking poli-
ticians, to regiment physicians into state medi-
cine, if successful, will lower the standards
of medical practice, give cheap and inefficient
service to the sick, and stifle progress in the
science of medicine and surgery.
REFERENCES
1. James Marion Sims: The Story of My Life. D.
Appleton & Company, New York, 1886.
2. Haagensen, O. D. and Lloyd, Wyndam, E.B.:
A Hundred Years in Medicine. Sheridan House,
1943.
3. Haggard, Howard W.: Devils, Drugs, and Doctors.
Harper and Brothers, New York and London,
1929, .
4. The Columbia Encyclopedia; Columbia University
Press, New York, 1837.
5. Garrison, Fielding' H. : An Introduction to the
History of Medicine. W. B. Saunders Company,
New York, 1929.
6. Finney, J. M. T.: A Surgeon’s Life G. P.
Putman’s Sons, New York, 1940.
7. Reid, Edith Gittings: The Great Physician. Ox-
ford Press, London, New York and Toronto, 1931.
8. Cushing-, Harvey: The Life of Sir William Osier.
at the Clarendon Press, 1925.
9. Knox, Rhoda: Joseph Lister, Father of Modern
Surgery. The Bobbs-Merrill Company, Indianapol-
is, 1944. .-V-'
10. Wilson, Charles Morrow: Ambassadors in White.
Henry Holt and Company, New York; 1942.
11. Kelly and Burrage: A Cyclopedia of American
Medical Biography. W. B. Saunders Company,
1912.
12. Congressional Report on Ether Discovery Honor-
able Edward Stanley of North Carolina and Hon-
orable Alexander Evans of Maryland. Thirty-
second Congress, first session, 1852.
THE SET OF THE SAIL
One ship drives east, another drives west.
While the selfsame breezes blow;
’Tis the set of the sail and not the gales,
That bids them where to go.
Like the winds of the sea are the ways of fate,
As we voyage along through life;
’Tis the set of the soul that decides the goal,
And not the storm and strife.
.p ssaj |jt.
'-'T'ifi v- v. ;.xi
Ella W. Wilcox (1855-1919)
Female Sterility Studies*
W. A. BEACHAM, B.A., B.S., M.D., F.A.C.S.*
New Orleans, La.
jrf . . ,
All of us twho practice obstetrics now have
first-hand knowledge of the fact that
Lhere is an upsurge in the birth rate in
this country during the time of war; further-
more, we have been impressed by the number
of childless couples who have come seeking re-
lief from their barrenness. Fortunately much
progress has been made during the past decade
in the study of sterility cases; consequently,
v/e can now offer that group of individuals in-
telligent stud'y of their problem with the
prognosis of a happy solution in the great ma-
jority of cases. No longer need the physician
suffer the embarrassment which used to come
about as the result of a patient bringing forth
her own baby within a year or *two afl;er she
had adopted an infant due to the fact that0
she had been told that she could never get
pregnant.
Gynecologists generally, define sterility as
the inability to conceive although in the
strict sense of the word it means inability to
reproduce offspring. Several types are recog-
nized, including the following: primary, in
which the patient has never conceived; secon-
dary, which indicates that pregnancy has pre-
viously occurred; relative, denoting a condition
in which the ability to conceive is lessened but
not absent; absolute, meaining complete al-
though not necessarily incurable inability to
conceive; and one-child sterility, in which in-
stance the wife becomes sterile after bearing
a single baby. In the literature the last men-
tioned is found in connection with uterine
fibroids although in this locality we see many
multiparae with numerous myomata.
It is now unanimously agreed by persons
conducting sterility studies that determina- *’
tion of the status of the male should precede
a detailed investigation of the female. It is a
good rule to insist upon complete examination
of the male after a careful history has been ob-
tained. The reproductive organs should be
thoroughly examined and the prostatic and
seminal vesicular secretion must be studied
"'Assistant Professor of Clinical Gynecology and
Obsletrics, Tulane University of Louisiana School
of Medicine.
grossly and microscopically. In the wet prepa-
ration one looks for pus cells, erythrocytes,
trichomonads, fungi, and other abnormalities;
while in the Gram stained material the or-
ganisms are classified. As a matter of rou-
tine a complete “blood picture” and serologic
tests for lues are obtained. A condom "col-
lected specimen of semen should always be
examined. The Huhner’s test must not be sub-
stituted for such an examination inasmuch
as we wish to know the amount, reaction, and
gross characteristics of the seminal fluid at
the time of its ejaculation. Obviously, we
should study the spermatozoa as to morphol-
ogy, number, motility, and endurance. A basal
metabolic rate and other indicated determina-
tions should be made.
In the case of the female, once again we
must stress the importance of obtaining a com-
plete history and of performing a thorough
physical examination. The historical data must
begin during early childhood with particular
emphasis on diseases which migh cause sterili-
ty. Information regarding the menarphe with
a story as to the behavior of the “menstrual
periods” is very important. One must know
about the occurrence of dysmenorrhea or other
abnormalities of menstruation. It is very im-
portant to know whether the pationt has ever
been pregnant. One of the most pathetic types
which may be encountered is the one who
gives a history of a sterilizing pelvic infection
which followed an inducted abortion shortly , ,
after marriage at which time she and her
husband agreed that they could not afford to’
have a baby. In later years the same couple ,t ,3
may have accumulated considerable goods of ,,
A'this world, bht due to the|rj early folly they
cannot have that which they most desire —
offspring > of their own. However, here again
they can be told the facts after proper in-
vestigation.
The history in infectious diseases, opera-
tions, and intra-abdominal catastrophes are
all of paramount importance. Sexual history
reveals facts as to libido, orgasm, dyspareu-
nia, frequency of coitus, time of intercourse
with reference to menstruation, effluvium sem-
424
Female Sterility — Beacham
425
September, 1945
inis, contraceptives, and the like. If the hus-
band has been previously married, it is im-
portant to ascertain if his wife became preg-
nant.
Physical examination must be thorough in
every sense of the word. The external and in-
ternal genitalia require very careful scrutiny.
The pH of the vaginal and cervical secretions
should be obtained, and wet as well as Gram-
stained preparations should be studied. Ma-
terial obtained from the urethra and Skeene’s
glands is similarly stained as a matter of rou-
tine. Particular attention is paid to the cervix
uteri regarding its position, size, shape, and
the presence or absence of the following :
erosions, eversions, nabothian cysts, lacera-
tions, polypi, and other new growths, etc. The
character, gross and microscopic, as already
mentioned, of the secretion present in the cer-
vical canal is of considerable importance; fur-
thermore, we must test the patency of the
canal and the mobility of the cervix. The cor-
pus uteri is examined as to position, size,
shape, consistency, and mobility. In a given
case uterine retroversion may be responsible
for sterility, nevertheless one should not be
too hasty in explaining the patient’s barren-
ness on a malposition. The correct use of a
Hodge or Smith pessary may prove very ad-
vantageous in such a condition. By vagino-
abdominal and recto-vagino-abdominal palpa-
tion one should examine the ovaries and sal-
pinges as to position, size, shape, consistency,
and mobility. The elicitment of abnormal ten-
derness calls for proper evaluation. In this
connection, it seems hardly necessary to say
that catheterization prior to pelvic examination
not only provides an ideal specimen of urine
for gross, chemical, and microscopic study,
but also insures a state of emptiness of the
urinary bladder which is important to both
examiner and patient. Blood is regularly ob-
tained for tests for syphilis and sedimentation
rate. A complete “blood picture” and subse-
quently basal metabolic rate determinations
are indicated. Special blood studies, such as
that of the Rh factor, should be done in cases
who give a history of spontaneous abortions.
Provided the husband has successfully
passed his tests, the next step is to make a
post-coital investigation of the vaginal and
cervical canal contents noting the average
number of spermatozoa present per high pow-
er field and the condition of the sperms.
Once again wet and stained preparations must
be studied. Cases of cervico-seminal incompati-
bility respond nicely to therapy.
The next step is to determine whether or
not the patient ovulates. It would be to our
diagnostic advantage if all women noticed
Mittelschmerz or slight intermenstrual “spot-
ting,” but seldom is the sterility case so lucky.
Our best method then to check up on ovulation
in the endometrial biopsy. Agreeing with Dr.
Edwin Hamblen, I prefer to obtain the endo-
metrium within twelve hours of the onset of
the menstrual flow. In a few cases the speci-
men for histological study is obtained within
a day or two of the anticiptated menses, bear-
ing in mind the fact that a very early preg-
nancy might be interrupted by such a pro-
cedure. The Novak suction curette and the
Burch uterine biopsy forceps are both quite
satisfactory for securing the tissue. During the
past two years the sterility patients who have
sought my advice have been instructed to keep
basal temperature records, but the majority
of these records have not proved very valuable
in estimating the time of ovulation. However,
important information is placed on such rec-
ords and my patients will be asked to continue
to keep them. Recently the Planned Parent-
hood Federation of America, Inc., 501 Madison
Avenue, New York 22, N. Y., has made avail-
able for three cents each basal temperature
charts and accompanying instruction forms.
The next procedure is the testing of tubal
patency, for which I prefer hysterosalpingog-
raphy. Such roentgenographic studies have
the following advantages over insufflation
tests: 1) there is a record in black and white
of the status quo, 2) the site or sites and ex-
tent of obstruction is or are accurately local-
ized, 3) the internal configuration of the uter-
us is determined, 4) the position of the uterus
is shown, and 5) the size, contour, length
and position of the unoccluded lumina of the
salpinges are demonstrated. Some of us con-
tend that the use of hysterosalpingographic
media is less dangerous than the employment
of gas in that the former is subject to better
control in that it gravitates down into the
cul-de-sac of Douglas while the latter tends
to rise up under the diaphragm, and secondly
that the radio-opaque media is at least bac-
teriostatic. My personal experience with skio-
dan-gum acacia solution (introduced by Dr.
Paul Titus and sold by the Winthrop Chemical
Company) has been such that I employ it
routinely. Inasmuch as both skiodan and gum
426
Female Sterility — Beacham
September, 1945-
SUMMARY AND CONCLUSIONS
1. The number of persons seeking informa-
tion regarding female and male sterility has
increased appreciably during the past three
years.
2. Determination of the status of the male
must precede a detailed investigation of the
female.
acacia can be injected intravenously, they
make a very nice solution to be instilled into
the uterus and tubes with the hope of spillage
into the peritoneal cavity. The skiodan is
absorbed from said cavity and is excreted by
the kidneys, a fact which we have demon-
strated roentgenographically, Obviously, asep-
tic technique must be employed and proper
judgment must be exercised if complications
are to be avoided. The literature contains ac-
counts of catastrophes following tubal insuf-
flation tests but these should be blamed upon
the investigator in each instance and not on
the test.
7. Figures are shown demonstrating hystero-
salpingographic findings in five cases investi-
gated from the sterility point-of-view.
8. In a subsequent article, the management
of sterility in the female will be discussed.
3. In studying the wife, one must obtain a
complete history and perform a thorough phy-
sical examination. It is necessary to obtain the
pH of the vaginal and cervical secretions
which must be studied as wet and stained
preparations. Vagino-abdominal and recto-
vagino-abdominal operations must be perform-
ed with accurate thoroughness.
Fig. 1. — Hysterosalpingogram showing a unicor-
nuate uterus with occlusion of the salpinx in its
distal third due to postoperative adhesions. Salpin-
gostomy has been recently performed.
4. Serologic tests of syphilis, blood sedi-
mentation rate, and complete “blood picture”
are a part of the routine. Basal metabolic rate
determinations and special blood studies should
be made as indicated, after the performance
of a Huhner’s test.
5. The matter of ovulation is best checked
by endometrial biopsy. The history of Mittel-
schmerz or slight intermenstrual “spotting” is
of historical value. Basal rectal temperature
records should be kept but should not be sub-
stituted for microscopic study of the endo-
metrium.
6. The best method of testing patency of
the fallopian tubes is hysterosalpingography.
The advantages of hysterosalpingographic
studies over salpingal insufflation procedures
are set forth.
Fig. 2. — Bicornuate uterus with roentgenograph—
ic demonstration, of bilateral tubal patency.
.'September, 1945
Female Sterility — Beacham
427
Fig. 3. — Hysterosalpingographic evidence of third
degree uterine retroversion. The left fallopian tube
is not visualized due to insufficient radio-opaque
material.
Fig. 5. — Normal X-ray findings in a 32 year
nulligravida who has regular anovulatory menstrual
cycles.
Fig. 4. — Same as Figure 3 plus visualization of
left tube. The use of a Hodge ppssary resulted in
.conception in this 38 year nullipara. She was section-
, ed at term six months ago.
Fig. 6. — Normal uterosalpingographic picture
after hysteropexy and myomectomy. This patient
has been recently delivered of a normal male at
term.
Separation of the Medical Profession from the
Armed Services
J. P. WALL, M.D .*
Jackson, Miss.
There is a lilt to a martial air, a glamor
to the uniform and a fascination to orderly
array that appeal to red-blooded men. In
all of us these is something of the hero and
hero-worship. Especially is this true, when our
hero is a conquering one.
That the medical profession of Mississippi
has demonstrated its true worth is evidenced
by the fact that its members volunteered their
services to this great nation in its time of
peril — a time that was a challenge, not so
much to our way of living, but even to the
right to live.
Mississippi doctors volunteered for duty be-
cause they had that indescribable, intangible,
and ineffable quality that is known as a “sense
of duty”. Of the entire group of Mississippi
doctors there were only six who put per-
sonal interests above those of their country
and declined to accept commissions when ten-
dered them. However much these men may
rationalize as to why they refused, still the
fact remains that they offered words when
deeds were needed.
The Mississippi State Medical Association in
its annual meeting in 1943 instructed the
councilors of the nine councilor districts of
the state to name from every county an
advisory committee to the state chairman of
the Procurement and Assignment Services for
Physicians. The state chairman has invaria-
bly, with one exception, followed the advice of
these committees, when this advice was sought.
These committees were and did act in an ad-
visory capacity, for which the state chair-
man hereby acknowledges their great help,
without which his work could not have been
carried on, and expresses to them his thanks
for the impartial way in which they have
served the profession and the nation in this
work, that did require wisdom, justice and
fidelity to a trust. These committees, as their
entitling would indicate, acted in an advisory
capacity to the state chairman, on whom, af-
ter all, did rest the responsibility in every
case for final judgment.
*Chairman of the Procurement and Assignment
Service for Physicians of Mississippi.
As of April 15, 1942, therb were in the
state of Mississippi 1330 doctors. This, mind
you, included all classes, those who wers ac-
tive, partially active and inactive.
Of this number 314 volunteered their seh-'
vices. Seventy-nine were declined because of
disabilities. Four were declined for reasons
other than physical. Seventeen have been
separated from the services, receiving honor-
able discharges. This leaves 214 men in the
services as of September 1, 1945.
Now since V-J Day has come with all of
the glorious prospects of an early return to
their homes of these men who have gone to
the far-flung theaters of operation, have risk-
ed their all that we might live, they are
wondering when and how they may be per-
mitted to resume their places in a civilian ca-
pacity.
From the press it is known that there will
be substantial reductions in the fighting
forces, and, accordingly, the medical corps
may be expected to share also in this de-
mobilization process, but it must be remember-
ed that:
1. Time will be necessary for personnel to
complete their work in foreign areas and
return to this country.
2. There probably will be replacement of medi-
cal department personnel in foreign oc-
cupational zones by those who have not
had overseas duty, and of an age below the
draft limit.
3. There still remains a necessity of maintain-
ing a high standard of medical care.
4. It may be expected that for several months
the evacuation of the sick and wounded will
continue.
5. That the heavy load of hospital patients
in this country will continue for at least
six months longer.
6. That the shrinkage in medical officers will
not be in the same proportion as the re-
duction of the armed services as a whole.
7. That the quota of 60,000 medical officers
reached approximately 55,000.
8. That the demobilization of the armed forces
means every man and woman must be
given a thorough physical examination.
428
September, 1945
The Mississippi Doctor
429
The following may be taken as what to ex-
pect:
1. Officers whose services are essential to the
armed forces will not be separated from
the services.
2. Officers from 50 years, whose specialist
qualifications are not needed within the
services will receive a high priority for re-
lease from active duty.
3. Adjusted service rating will be utilized as
a definite guide to determining those who
are to be separated from the services.
The procedure for a doctor desiring
to get out of the services, so far as to the
Procurement and Assignment Services for
Physicians is concerned, is as follows:
1. The officer addresses a letter, in triplicate,
to the state chairman, indicating that it is
his intention upon discharge to return to a
certain locality to resume the practice of
medicine.
2. Statement, in triplicate, from the advisory
committee of his county that he is needed
in the home location.
3. On receipt of this data, the state chairman
towards it to the Appeal Committee in
Washington, who passes on the state chair-
man’s recommendation.
4. On receipt of the action of the Appeal Com-
mittee in Washington, the state chairman
then forwards two copies of the report of the
Appeal Committee, two copies of the state-
ment of the advisory committee of his coun-
ty to the officer in question, and then the
officer passes this data through channels
up to the Adjutant General, who will de-
termine whether this officer is to be separ-
ated from the services — his decision rest-
ing mainly on the question whether a “suit-
able replacement is available.”
5. The experience of this office has been that
the more forcible and hearty the endorse-
ment of the officer’s immediate superior
commander, the better are the changes of
the final approval of his application.
Again, permit the state chairman to ex-
press his thanks to the medical profession
of our state for the whole-hearted way (with
a few exceptions) they have cooperated, the
spirit that has characterized their action, the
unselfish aid of the advisory committees, and
the headquarters of the state Selective Ser-
vice system and the Mississippi State Board
of Health for its aid in carrying on a work
essential for our country’s cause.
rpHE VICTORY MEETING of the
Southern Medical Association will
be held under the sponsorship of the
Campbell-Kenton County Medical So-
ciety of Kentucky in Cincinnati, Ohio,
November 12-15. It is a Kentucky
meeting. The Southern Medical Asso-
ciation meetings always have been and
always will be the essential meetings
IN and FOR the South. The Southern
as an essential medical organization has
carried on without a break during the
war — it has not missed a meeting. Now
it will celebrate the victory with a great
VICTORY MEETING. In its twenty-
one sections, two general sessions, six
conjoint meetings, and the scientific
and technical exhibits, in a streamlined
program, one will get the last word in
modern, practical, scientific medicine
and surgery.
REGARDLESS of what any physician
may be interested in, regardless of how
general cr how limited his interest, there will
be at Cincinnati a program to challenge that
interest and make it worth-while for him to
attend.
A LL MEMBERS of State and County
medical societies in the South are cor-
dially invited to attend. And all members
of state and county medical societies in the
South should be and can be members of the
Southern Medical Association. The annual
dues of $4.00 include the Southern Medical
Journal, a journal valuable to physicians
cf~the South, one that each should have on
his reading table.
SOUTHERN MEDICAL ASSOCIATION
Empire Building
BIRMINGHAM 3, ALABAMA
430
Editorials
September, 1945
The Mississippi Doctor
Published monthly at Booneville, Mississippi
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
Official Organ Of
Mid-South Postgraduate Medical Assembly
Mississippi State Medical Association
W, H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
Mid-South Postgraduate Medical Assembly
Officers :
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D, President-Elect
Nashville, Term.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore. M. D Vice-President
El Dorado, Ark.
-A. F. Cooper Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis. Tenn.
Editors :
Fay H. Jones, M.D. E. M. Holder, M.D.
C. R. Crutchfield, M. D. C. M. Speck. M.D.
H. King Wade, M. D, F. M. Acree, M.D.
Mississippi State Medical Association
Editor
Lawrence W. Long, M.D.
Associate Editors
T. G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life Building,
Jackson, Mississippi.
Our readers are no doubt enjoying the two
parts of Dr. Seale Harris’ treatise on Marion
Sims and other nineteenth century pioneers.
We appreciate this article from the pen of
Dr. Harris. Interesting and well written, it
unfolds almost like a romance. The medical
public is anxious to have Dr. Harris’ books
on Banting and Sims and others. In Dr.
Harris is embodied the spirit of Southern medi-
cine, patroit, scholar, and courtly gentleman.
The four-year medical school, the medical
school hospital, and the state hospital system,
are as the driver, the vehicle and the motive
power of a planter. It takes all three to get
the job done. The four-year school is the
driver, the doctors, nurses and interns in and
out of training, constitute the power, and the
hospital system with its equipment is the
vehicle in which the service is delivered. It
seems now that it is time for Mississippi
to own and till her lands and quit working on
the shares.
Blue Cross Insurance is on its way to Mis-
sissippi we believe. It will bring with it a
great blessing. It is good not only to pay
as one goes, but to pay in advance for sick-
ness that may come any time. If it does not
come one is the more fortunate and at the
same time helps others. It is now stated that
Blue Cross has 18,800,000 members. Seventeen
thousand per day are now joining. The big
challenge to Mississippi now is a hospital sys-
tem that will enable every person who wants
it to have Blue Cross Insurance.
Thanks to Dr. Allen E. Cox for his renewal
to the Mississippi Doctor. He is a past presi-
dent of the Mid-South and one of the corner-
stones of this organization. He suggests that
the Mid-South have a meeting in February
so as to begin functioning again. This is worthy
of serious consideration.
News and Comment
NORTHEAST SOCIETY HONORS
MEMBERS
The third quarterly meeting of the North-
east Mississippi Thirteen Counties Medical
Society met at Amory on September 11, 1945.
It has been customary to meet once a year
in Monroe County to do honor to Dr. G. S.
Bryan of Amory.
The meeting was called to order by Presi-
dent W. J. Aycock with Secretary W. H. Cleve-
land at his place. In vain the audience a-
waited the sage of the State Medical Associa-
tion and the spirit of our Thirteen Counties
Society. His spirit could be felt, but his
person could not be seen.
Dr. V. B. Philpot asked for the privilege
of the floor and read a message from him
as follows:
News and Comment
431
FROM DR. BRYAN
Written to be read at the past meeting of the
'Northeast Mississippi Thirteen Counties So-
ciety in Amory.
The lines that convey this message to you
are the first that I shall have written since
I fell sick on the fourteenth day of last Jan-
uary. I will try to make this message brief.
This society had its beginning in 1903. I
was a charter member and have been a con-
stant attendant upon its meetings. When I
became a member I enlisted for the “duration”.
I was deeply interested in the work it under-
took to do and I soon learned to love its
membership both collectively and individually.
Marty of the happiest experiences of my life
came to me through my contacts with its
membership. I am also very fond of the
members- of the Ladies’ Auxiliary. They are
entitled tu this fondness in their own right,
but it is based largely upon my love for their
husbands.
It is probable that I shall never be able
to discharge the duties of active membership
in the society again. So I ask and will plead
with all of you to resolve that the ideals and
high purposes of the society shall never be
allowed to grow less. PleaseL do not permit
policies to be influenced by selfish motives,
but be ready, at any and all times, to back
and support every measure that can be help-
ful in forwarding progressive medicine or in
elevating professional standards. I want to
thank you all for the many ways that you have
been helpful to me during the many years
that we have been associated together. Many
of you are growing weary with the weight
of accumulating years as am I. Be strong
and courageous for yet awhile.
To the younger members who will soon be
relieved from military duties, we older ones
hand you the torch — we have striven to hold
it high in your absence. We have faith in
you. We hope, yea we know, you will not
let it be lowered.
Now a request of a personal nature. Since
I may not mingle with you as in the past,
please visit me in my home or wherever I
may be found. I look forward to your visits
as the chief source of future pleasure.
In conclusion, may God bless you all, both
collectively and individually. Au revoir!
G. S. B.
Dr. W. A. Evans of Aberdeen now obtain-
ed the floor and read the following:
Change in By-laws of Northeast Missis-
sippi Thirteen Counties Medical Association by
adding to Section 2 “Members” next to the
last paragraph by inserting after word so-
cieties, Honorary, A section 3, now reading
“Honorary Fifty-Year Club Members”. Phy-
sicians in the boundaries of this District Medi-
cal Society who graduated fifty or more
years prior to the meeting of election shall
be eligible for a button and certificate setting
forth the facts. These emblems shall be
bestowed at a public meeting.
As such member he shall be freed from
the obligation of paying dues. As such
member he shall have the rights in this
Society and the State Medical Association of
attending meetings, taking part in scientific
and business discussions, of voting, and of
election to office including committee member-
ship.
Amendment adopted September 11, 1945 at
the regular meeting of the Society at Amory,
Mississippi.
He also offered an amendment to the
state constitution to be acted upon at our
next meeting. Both were adopted and the chair
appointed Drs. R. B. Caldwell, V. B. Philpot
and W. H. Anderson to carry the latter before
the House of Delegates at its next meeting
and see that it is voted upon.
A motion was made and passed without
a dissenting vote to make Drs. G. S. Bryan,
W. A. Evans, J. Rice Williams and W. C. Wal-
ker honorary members of the Northeast Mis-
sissippi Thirteen Counties Medical Society. The
president appointed a committee to convey
this message to Dr. Bryan and to reply to his
letter just read. The committee, composed of
Drs. W. A. Evans, V. B. Philpot and W. H.
Anderson, proceeded to the residence of Dr.
Bryan where they were cordially received and
the message delivered, with Dr. Evans as
spokesman.
“Dr. Bryan, we come as messengers from the
Northeast Mississippi Thirteen Counties Medi-
cal Society in session at the Park Hotel. Your
letter was read to the doctors present. It was
received with a deep interest and with a feel-
ing that evidenced brotherly love and with an
appreciation of your life work and your active,
safe, and progressive leadership in this society
for so many years. It was received like a final
message of a father to a son, but there was
evidence of earnest hope that you may be able
again to attend the meetings, may we say, of
432
News and Comment
September, 1945
your Society. This society expresses the prayer-
ful hope that you may have many more years
of activity, but at the same time it assures
you that you have already lived a life of
oustanding accomplishment to organized me-
dicine, to your clientele in practice, and to
your town and state as a citizen.
“We also wish to inform you that first on
the list today you have been made an honor-
ary member of this society on having prac-
tised as a physician for fifty years or more
tised as a hysician for fifty years or more
and that it hopes you will be first to be so
honored at our state meeting next year as a
member of the Fifty-Year Club.
“We hope for further restoration of your
health that we may be able further to profit
by your knowledge and your wisdom.”
PROPOSED AMENDMENT TO STATE
BY-LAWS
Purpose :
To stimulate interest and continued at-
tendance in state and local medical societies
of physicians over seventy years of age and
to encourage the adoption of hobbies, principal-
ly medical history, of the members of this
club.
Machinery :
A club shall be composed of physicians who
have been in practice fifty years to be known
as the Fifty-Year Club*. This club shall be
at the time of the annual meeting of the
State Medical Association in one session, to
be organized and operated under the auspices
of the State Medical Association Method. When
evidence becomes available which evidence
shows that a given physician was graduated
from a medical college fifty years ago the
component medical society (county or dis-
trict) to which he belongs shall elect him
to honorary membership and have a public
meeting attended by the profession, visitors,
mayor and other citizens. At this meeting the
special classification shall be accompanied by
a note, speeches, music, banquet and presenta-
tion of button and certificate setting forth
membership to the honorary club, the Fifty-
Year Club.
The secretary of the component club shall
notify the secretary of the State Medical
*A suggestion was also made that the limitation
be forty years in practice and if the body so de-
termines, where the word fifty occurs a change shall
be made to forty throughout the amendment.
Society and the executive of the Fifty-Year
Club.
The person so elected becomes an honorary
member Of the State Medical Association with
rights and duties as such.
To accomplish these ends the Constitution
of the State Medical Association and By-laws
should be amended as follows:
Amend Article IV Section 4 (last paragraph
Volume one, page 39) by inserting new sec-
tion (Section V) reading as follows:
Any component society may submit in writ-
ing the names of such physicians who have
been graduated in medicine fifty or more years
ago and who live within the limits of that
component society and who have been elected
by that society as honorary members and
whom the House of Delegates shall then elect
as honorary members of the state society.
The honorary Fifty-Year members of the com-
ponent medical societies and of the State
Medical Association^, shall not be required to
pay dues.
They shall have the duty of attending the
annual meetings of the State Medical As-
sociation and the regular meetings of the com-
ponent society to which they belong.
As such members they shall have the rights
of partaking in discussions, scientific and
business, of presentation of papers, of voting,
of holding of office, including committeeships,
of the state and component societies and of
membership in the Fifty-Year Club.
The Fifty-Year Club shall be considered as
a committee of the State Medical Association.
It shall be composed of members elected to
it by the component societies of the State
Medical Association. Its membership shall
consist of persons who graduated fifty or
more years before the meeting at which they
are made eligible.
Its only officer shall be a director and
secretary elected by the membership of the
club at any meeting thereof. The club shall
hold one session a year and this at the time
of and in connection with the annual meet-
ing of the State Medical Association.
Its purpose shall be to stimulate continued
interest of its members in and attendance of
meetings of the State Medical Association, to
promote interest in medical hobbies and es-
pecially in local medical history.
Change Chapter IX, Page 44, 2nd Col., by
inserting after medical education the words
Fifty-Year Club.
September, 1945
News and Comment
433
MRS. WATES SUCCEEDS DR. GAY
Mrs. Elizabeth Nisbet Wates of Jackson was
named state commander of the American
Cancer Society at a meeting of the state
executive committee, of which Dr. Felix J.
Underwood is chairman. The state office of
the American Cancer Society will be opened in
the Lorenza Building on Amite Street in Jack-
son. “The program will be carried out on a
state-wide basis with a unit captain in each
county. We are now ready to begin a con-
certed attack on cancer which last year took
the lives of 1600 Mississippians,” said Doctor
Underwood.
Doctor Emma Gay of Biloxi, former state
commander, has accepted responsibility for
the regional medical education program of the
American Cancer Society and will also serve
as district commander and member of the
state executive committee.
PROCUREMENT OF SURPLUS MEDICAL
SUPPLIES BY VETERANS
The new veteran priority ruling gives veter-
ans who operate a small business or enter-
prise the right to purchase surplus property
direct from the government through the
Smaller War Plants Corporation, rather than
buying through regular dealers. A small busi-
ness or professional enterprise is defined as
“any commercial, industrial, manufacturing,
financial, service, legal, medical, dental, or
other lawful enterprise (other than agricul-
tural) having an invested capital not in ex-
cess of $50,000, which a veteran maintains or
desires to establish : provided, that he is or will
be, directly or indirectly, the sole proprietor
thereof or that no person or persons, other
than other veterans, have or will have any
proprietary interest in the enterprise, singly
or together, directly or indirectly, in excess
of 50 per cent of either the capital invested
in such enterprise or of the gross profits or
income thereof.”
The procedure for procuring surplus supplies
and equipment by veterans was established in
Surplus Property Board Regulation, dated 26
May, 1945, certain paragraphs of which are
especially applicable to doctors and dentists
who are veterans and who may desire to pur-
chase surplus supplies and equipment to es-
tablish themselves in their profession. The
Smaller War Plants Corporation at present
has district offices in ninety-seven of the
larger cities of the United States.
The district office for Mississippi is located
in the Tower Building, Jackson, Mississippi,
telephone 3-4941. At present, there is no in-
dication of the extent to which medical and
dental supplies and equipment will be available
to doctors and dentists on their release from
active duty. Surplus lists will be screened
for other federal agencies before becoming
available to veteran doctors and dentists.
IN THE SERVICE
Hollandia, Dutch New Guinea
Headquarters
334th Station Hospital
Office of the Commanding Officer
APO 565
SBW/dvh
16 August 1945
Dr. W. H. Anderson,
Editor, Mississippi Doctor,
Booneville, Mississippi.
Dear Dr. Anderson;
The recent issues of the Mississippi Doctor,
which you have been so kind to send, have
been received and read with great benefit
and pleasure.
After reading each issue, I pass them on
to Lieutenant Colonel Erskine Ross of Hatties-
burg, Mississippi, who is the chief of surgery
in our hospital. Colonel Ross came to us in
September of last year and has done an ex-
cellent job as chief of the surgical service.
Our hospital was in the chain of evacuation
of battle casualties from the Leyte and Luzon
campaigns. The treatment of all casualties
admitted was under the supervision of Colonel
Ross and his staff of surgeons. They handled
expertly and with dispatch all types of serious-
ly wounded.
It is a compliment to your association to
have one of its members accomplish such
fine results in treating wounded soldiers here
in the jungles of New Guinea.
Your thoughtfulness in adding my name to
the mailing list of your fine journal is sin-
cerely appreciated.
Yours very truly,
Buford Word,
Colonel, M. C.
We deeply appreciate the above from our
valued friend Col. Word, M.C. We appreciate
what he has to say about Lieut. Col. Erskine
434
Book Reviews
September, 1945
Ross. We were in college with Erskine at
Mississippi College and at Tulane. He has
measured up as we expected. We all feel proud
-of this son of a noble father in the profession.
—Ed
Book Reviews
Here is the book that everyone needs and a
large number will (want Penicillin Therapy In-
cluding Tyrothricin and Other Am biotic Ther-
aVy> by Dr. John A. Kolmer of Philadelphia
who is so well-known in the medical world.
The book is published by the D. T. Appleton-
Century Company, New York. It contains 285
pages and is dedicated to Sir Alexander Flem-
ing who discovered penicillin and Sir Howard
W. Florey who did so much in developing its
therapy. The book gives due consideration to
the discovery of this wonder medicine, and its
development and production, how to detect
it and how to measure the dose. Physical and
chemical properties of the drug are explained.
Antimicrobial activity and pharmacological
and toxic effects are discussed. The adminis-
tration of penicillin with discussions of the
routes and methods used to administer the
drug are supplemented with illustrations. The
author says that, “in spite of the fact that
much is yet to be learned about penicillin in
the treatment of disease and especially the
dosage, yet sufficient experience has clearly
defined certain principles in relation to the
importance of bacteriologic and other labora-
tory examinations, its indications and contra-
indications, administration, the need for sur-
gical and adjuvant therapy, prophylactic value
and causes for failure in treatment.” These
phases he discusses.
Special reference is made in the book to
penicillin in the treatment of the following
types of disease: staphylococcal, streptococcal,
pneumococcal, meningococcal, gonococcal, and
clostridial.
Dr. Kolmer says that “One of the most dra-
matic phases of penicillin therapy has been
its remarkable success in the prevention and
treatment of infections of wounds and bums.”
He discusses its application.
General consideration is given to penicillin
in the treatment of syphilis, primary and
secondary, and to its use in the treatment of
other miscellaneous diseases.
4 Tilnely, authentic, practical— this book is a
must” for the medical student.
Deaths
DR. J. M. FOSTER
Dr. John M. Foster, 65, who died August 9 in
a Birming-ham hospital, was buried in Nettleton,
where he was born February 24, 1880, was grad-
uated from Providence College there and completed
his medical training at the University of Tennessee
in 1910.
He had lived in Birmingham for 23 years, and
was widely known in medical circles. He became
ill several weeks ago, and asked leave from his
duties at Ketona Home for the Aged. He was also
physician for the juvenile court, a member of the
American Medical Association and the Jefferson
County Medical Association.
He was a Mason, a member of the Knights of
Pythias, and a member of the First Presbyterian
Church in Birmingham.
Surviving are his wife, Mrs. Birdie Tanner Fos-
ter, and a daughter, Mrs. Johnnie McNabb, both of
Birmingham, two brothers, O. B. Foster and J. p.
Foster, and a sister, Mrs. H. Y. Johnson, all of
Nettleton.
DR. M. E. ARRINGTON
Severely injured August 8 when his car crashed
head-on into the concrete bridge three miles south
of Winona on Highway 51, Dr. Marvin E. Arrington
of Vaiden died an hous after being rushed to a
Greenwood hospital.
The car was completely demolished and Dr. Ar-
rington pinned in between the front seat and dash-
board. It was necessary to pry him loose.
Funeral services were held at the aiden Metho-
dist Church, after which the remains were sent
to Brookhaven (Miss.) for burial.
Surviving him are three sisters, Mrs M. D,
Stringer of Winona, Mrs. K. C. Moon and Mrs.’
R. M. Ryan of Jackson, Miss.; and uncle. Dr. O
N. Arrington of Brookhaven.
Dr. Arrington was forty years of age and the
son of the late Mr. and Mrs. William O. Arring-
ton of Lincoln County.
Dr. Arrington was graduated from Tulane in
1931, served an internship with Newell and Newell
in Chattanooga, Tenn., before accepting an ap-
pointment as part-time health officer in Carrol
County, July 1, 1933. He was serving in that ca-
pacity at time of death.
DR. DEWELL GANN, SR.
Services were conducted September 26 at Ben-
ton, Arkansas, for Dr. Dewell Gann, Sr., 8 6 -year-
old prominent Saline County physician, who died
at his home there. Dr. Gann organized the first Sa-
line County Medical Society in 1903 and later served
as vice-president of the Arkansas Medical Society,
We all tend to rise or fall together. If any
of us raise ourselves a little, then by just so
much the nation as a whole is raised. If any
set of us goes down, the whole .nation sags
a little.
— Theodore Roosevelt
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg. cf'
Obstetrics and Gynecology— J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore,. Vicksburg, Miss.
Surgery — W. H. Parson**, Vicksburg.
Urology — Temple Ainsworth, Jackson.
PEDIATRICS
Acute Salicylate Poisoning — Hartmann,
Alexis Fv Journal of Pediatrics, (March 1945).
It is stated that fatal intoxication is not
infrequent and has occurred in about 50 per
cent of subjects developing symptoms serious
enough to lead to hospitalization. On the other
hand, suicidal attempts have often been fail-
ures despite ingestion of large quantities of
the salicylate drugs. No close relationship
between dosage and symptoms exists, but ex-
perimental observations indicate that with
blood concentrations which are likely to be ob-
tained during “intensive therapy, toxicity may
result without the requirement of unusual in-
dividual susceptibility.
The writer indicates that studies on the
antipyretic effects of the salicylates indicate
that their action is chiefly on the hypothalmus,
and leads to both increased heat production
and heat loss. Pain is relieved chiefly by their
depressant action on the optic thalami. Res-
piration is at first stimulated and then de-
pressed. Following periods of restlessness and
excitement, stupor and coma frequently occur.
In fatal cases gastric hemorrhages, liver dam-
age and renal injury with functional failure
have been described. Reduced coagulability of
the blood with hypoprothrombinemia may oc-
cur. Depletion of liver glycogen and tissue de-
pletion of vitamin C with increased urinary
excretion have been noted. Plant, animal and
435
yeast enzyme systems are affected, and the
respiration of rat liver and kidney slices is
reduced by M/10 concentration of salicylates.
Seven infants and one four-year-old child
have been admitted to the St. Louis Children’s
Hospital during the last ten years with severe
symptoms of intoxication. Three died — exactly
the same number as died from sulfonamide
drug intoxication during a slightly shorter
period. Except in one instance, when a twenty-
month-old infant found a box of 5-grain sodium
salicylate tablets and swallowed an undeter-
mined number (later vomiting fourteen par-
tially disintegrated tablets), all had been given
salicylates from therapeutic reasons, either at
the customary dosage of one grain per year
repeated every four hours or else no more
than four times such amounts. After first
showing the relatively mild symptoms of
“salicylism,” usually within twenty-four hours
of the beginning of drug administration, all
developed extreme hyperpnoea and became
comatose. Four had convulsions. All had real
bicarbonate deficit acidosis and very severe
evidence of circulatory and respiratory failure
for some time before death. One of the fatal
cases — the only one — had hyperpyrexia. Two
others had moderate fever. The writer felt
that in the five cases recovering, the effective
treatment was the large quantities of lactate-
Ringer’s solution and dextrose given over a
number of days and until ketosis had disap-
peared.
His conception of what transpires is this:
“At first there is primary hyperventilation be-
cause of central stimulation, which leads to a
C02 deficit type of alkalosis with alkaline
urine and moderate compensatory reduction
of blood bicarbonate. Then ketosis develops (in
one instance also with hypoglycemia) and
produces a real bicarbonate deficit acidosis,
with a shift to acid urine. Acidemia (reduction
of blood pH) may or may not result, depending
upon the degree of hyperventilation and wheth-
er or not respiratory failure ensues. Ketosis,
cannot be immediately abolished by adminis-
tration of glucose or glucose with insulin (the>
latter to be used with caution because of the>
tendency toward spontaneous hyperglycemia)5
436
State Board of Health
and may persist for as long as four of five
days, and requires ‘neutralization’ with repeat-
ed injections of Na-lactate or sodium bicarbon-
ate, the former preferred because of its gly-
cogenic properties, its greater safety, and
ease of administration. After ketosis is finally
abolished, salicylates may still be found in
the body fluids and there may still remain
hyperpnoea from central action with a shift
again of the acid-base balance to that of CO§
deficit alkalosis, requiring CO 2 inhalation
(usually with oxygen) to prevent alkalemia.
September, 1945
In fatal cases circulatory and respiratory fail-
ure develop.
COMMENT
It is felt that since many of us are giving
quite a great deal more of the salicylates now
than ever before, it would be well for all phy-
sicians to read this article. In the first place,
it represents the views and methods of
treatment by one of the best authorities in
America and on that account should demand
the attention of any physician who has the
opportunity to read it.
State Board of Health
Felix J- Underwood, M .D.
WARTIME PUBLIC HEALTH SERVICES
Wartime services rendered by the State
Board of Health and local health departments
covered a wide field and an unprecedented
volume of demands. The vital nature of the
work needing to be done elicited the fullest
response of public health personnel throughout
the state, with every individual feeling an add-
ed sense of duty and responsibility and gladly
assuming the added work which the emergency
imposed. As is to be expected when effort is
expended on so great a scale, much lasting
and constructive good is realized which can
be carried over as a peace-time asset. Such
has been the case in many areas of the public
health field. The gains which have been made
will strengthen any future program.
In the Industrial Hygiene Division, the im-
mediate emphasis was placed on increased pro-
duction of the essential tools of war. By fre-
quent inspection and consultation this division
assisted in providing more healthful working
conditions for the thousands of war workers
in the state. Regulations were adopted cover-
ing first aid, safety, sanitation, and reporting
of occupational diseases. Nurses and medical
services were augmented. Better nutrition pro-
grams were instituted in more than a dozen
of the larger industries. Equipment was made
available to collect and analyze air contami-
nants such as dust, vapors and fumes which
might be toxic to workers. Recommendations
were made and followed up to insure that
necessary ventilation was provided to remove
harmful substances from the workers’ en-
vironment. Chest x-rays were taken of thou-
sands of workers. It is believed that the ac-
tivities promoted by the Industrial Hygiene
Division brought about improvements which,
materially reduced absenteeism and accidents
and resulted in higher efficiency. Looking to>
a future of industrial expansion for Missis-
sippi, it is imperative that industrial hygiene
services be continued and increased as needed.
The Division of Preventable Diseases Control
was unusually active in putting to work new
measures for the control of communicable
diseases. An extensive program to curb ve-
nereal diseases was developed. Special efforts
were directed toward the reduction of respira-
tory infections, pneumonia, meningitis, typhoid
fever, typhus, tuberculosis, malaria, whooping
cough, measles, and other infectious diseases.
All divisions cooperated in carrying out the
objectives of this division to keep communi-
cable diseases at the lowest possible ebb.
Especially notable was the malaria control
work done through the Division of Sanitary
Engineering and the diagnostic work of the
State Hygienic Laboratory.
The Division of Vital Statistics reports that
the death rate in Mississippi has varied but
slightly during the past five years, averaging
around 9.5 per thousand population. Each
year the death rate has been below the na-
tional average, the white death rate being one
of the lowest in the United States. Fewer
September, 1945
State Board of Health
437
deaths were reported to have occurred in the
state in 1944 than during any year in the past
twelve years. Extremely low levels were
reached in deaths from typhoid fever, malaria
and pellagra, the combined total being 143.
Thirty years ago these three diseases pro-
duced 1850 deaths. Tuberculosis in thirty years
had dropped from first place to sixth place
as a cause of death in the state. The ten lead-
ing causes of death in Mississippi in 1914 and
in 1944 are as follows.
1914
1. Tuberculosis
2. Pneumonia
3. Pellagra
4. Malaria
5. Diarrhea and Enteritis
6. Early Infancy
7. Typhoid Fever
8. Cancer
9. Accidents
10. Homicide
1944
1. Heart Disease
2. Nephritis
3. Intracranial Lesions
4. Cancer
5. Accidents
6. Tuberculosis (all forms)
7. Pneumonia (all forms)
8. Influenza
9. Premature Births
10. Senility
Oustanding activities of the Division of Ma-
ternal and Child Health included:
k 1. The inauguration of the Emergency Ma-
ternal and Infant Care Program in Mississippi
for wives and infants of men serving in the
armed forces.
2. The development of a Child Guidance
program under the direction of Dr. Estelle A.
Magiera to assist in alleviating the emotional
and social illnesses of children.
3. The inclusion in the general health pro-
gram of activities designed to encourage a
greater sense of responsibility for family
planning, with emphasis upon complete phy-
sical and emotional convalescence of the mo-
ther between births.
4. Refresher courses for Mississippi physi-
cians in obstetrics, gynecology, and pediatrics.
5. The inspection of maternity and nursery
hospitals and clinic facilities to insure the best
standards possible for protecting the health
of mothers and infants.
6. Routine prenatal and postpartum nursing
and medical maternity services; also infant,
preschool, and school examinations.
In all activities the local health departments
have cooperated fully. In addition to routine
work, county health departments furnished
many special services to the armed forces.
Health officers served as examiners for Selec-
tive Service boards. Laboratory services were
furnished to selectees examined by local
boards. Sanitary regulations were enforced and
regular inspections made of trailer camps,
dairies, food establishments, and of water and
sewage extensions in or near cantonment
areas. Clinics for treatment of venereal dis-
eases were established and close cooperation
given to military personnel in locating con-
tacts. Selectees rejected because of tuberculo-
sis were followed up and sanatorium admit-
tance arranged whenever possible. In carrying
out the many wartime health activities much
constructive good has been accomplished.
The School Health Service, administered
jointly by the State Board of Health and the
State Department of Education, received new
impetus. In this program special attention is
given to training teachers through workshops
to enable a broader understanding of health
problems. Emphasis is placed upon the cor-
rection of children’s defects, adequate school
lunch programs, the sanitation of the school
buildings and grounds, and the provision of
safe drinking water and sewage disposal facili-
ties. Approximately 300 high schools partici-
pated in the National Victory High School
program to furnish physical education, health
examinations and recreation to high school
age children to encourage a higher degree of
physical fitness. Assistance was given in the
development of the nutrition phase of the
school health program. Aided by the War Food
Administration, lunchrooms were established
in about 500 schools in the state, a number
later expanded to more than 900 schools. Well-
balanced lunches were served to more than
118,000 children daily during the school term.
Improved food production, food conservation
and greater knowledge of food values by
adults as well as children are visible evidences
of the value of this service. During the sum-
mer of 1945, alone, approximately one thou-
sand teachers participated in the workshops.
438
State Board of Health
September, 1945
The Medical Library proved its value as a
center of information on all subjects vital
to : the health interests of the people of the
state! Busy physicians, hard-pressed fry mount-
ing demands upon their time telephoned or
wrote in for needed references; public health
Workers engaged in one of the broadest of
health programs depended on the library to
supply needed information to insure the suc-
cess of their many and varied activities. Phy-
sicians, dentists, nurses, laboratory technicians,
and special groups devoted to vital health
projects, used the Library’s resources freely.
With " its well-rounded collection of six thou-
sand volumes, including many important mono-
graphs and long runs of journals, the Library
is an imposing asset in the continuing war
against disease. Through its services the rapid-
ly expanding scientific knowledge of this period
is made readily available.
.V. .v. ,y. .v. ,y.
vv Y» vv <v vv
MISCELLANEOUS NEWS
Mineral Oil vs. Cooking Fats
All over the state tremendous quantities of
mineral oil are being sold in grocery stores.
Seemingly, large numbers of familiees are
using mineral oil for frying, in breads, to
make mayonnaise, and for other cooking pur-
poses. This indiscriminate use of mineral oil
is dangerous and should be avoided.
First of all, mineral oil has no nutritional
value. Only minute amounts are absorbed. But,
aside from this negative value, mineral oil
may actually be harmful. Mineral oil interferes
with the utilization of carotene and the fat
soluble vitamins A, D, and K. and also with
the utilization of the minerals calcium and
phosphorus. Therefore, its continued use may
lead to nutritional deficiency conditions. Ani-
mal studies indicate that mineral oil may cause
lesions of the liver. It seems reasonable to
suppose that keeping the intestines coated with
mineral oil might interfere with all food utili-
zation.
Since the United States as a whole will
probably be short on fat until at least 1946,
we need to help people learn to use less fat.
Vegetables can be seasoned with butter or
margarine. Eggs can be soft cooked, hard
cooked, or poached. Bread can be made with
less fat in many homes.
Margarine — if fortified with Vitamin A,
is the equal of butter, nutritionally speaking.
The Enrichment Program still needs the
active support of every person interested in
better nutrition. All of the flour and bread
being sold in Mississippi now must be enriched.
The chemist has tested samples of all flours
blended in Mississippi and found them properly
enriched. Many bread samples have been
checked, and some of them were not adequate-
ly enriched. The bakeries are correcting errors
promptly in the case of under-enrichment,
however.
Corn enrichment is not as complete as flour
enrichment. The wholesale grocers were noti-
fied that they must have their stocks cleared
of all non-enriched degerminated meal and
grits by August 1. All non-enriched meal and
grits must be off retail shelves by September
1.
Eleven corn mills were supplying Mississippi
with enriched meal and grits before August 1.
Four other mills will have their products en-
riched very soon.
Eleven states and Hawaii now require that
all flour and bread must be enriched. Missis-
sippi, Alabama, Georgia, South Carolina and
North Carolina also require that degerminated
meal and grits be enriched.
*****
Dr. R. D. Dedwylder Completes 25 Years With
Health Department
“On July 1, Dr. R. D. Dedwylder completed
twenty-five years of service as director of the
Bolivar County Health Department. In 1912
he gave up private practice and joined the
State Board of Health with the Rockefeller
Foundation for the study of hookworm in the
South. He stayed with the Health Department
until July 1915, when he took a vacation and
attended Tulane University for postgraduate
work.
“On completion of this work he again accept-
ed a place with the State Health Department
and the Rockefeller Foundation in the study
of malaria and malaria control. He came to
Cleveland at this time with four other doctors
and ten technicians to engage in an extensive
demonstration of malaria control.
The force was cut at the beginning of the
first World War and Dr. Dedwylder and the
remaining four technicians were sent to Sun-
flower County to carry on the study of malaria
until 1920.
“On July 1, 1920, Cleveland was selected
for the first full-time health departmeent in
the state, and one of the first in the South.
September, 1945
Woman’s Auxiliary
439
Dr. Dedwylder was named Health Officer and
Director, and has remained in charge to the
present. He has built up the Health Depart-
ment from the original personnel of a director
and four technicians to one of the largest
health units in the state.”
— Bolivar County Democrat , July 5, 1945.
womans Auxiliary
President Mrs. L. J. Clark
Vicksburg:
President-Elect Mrs. Stanley Hill
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording: Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson . .
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
WINONA DISTRICT AUXILIARY
The members of the Auxiliary to the Winona
District Medical Society met August 14 at
Kosciusko in a joint meeting with the doc-
tors at the Rotary hall. Following a delightful
luncheon the members motored to the home
of Mrs. S. L. Bailey, president for the pro-
gram.
Mrs. L. J. Clark of Vicksburg, president of
the state organization, was a guest, bringing
special greetings and stressing enrollment and
publicity of the group’s endeavors.
Mrs. Edgar Giles presented the facts of
socialized medicine as embodied in the Mur-
ray-Wagner-Dingell bill, and how it will af-
fect the medical profession if it becomes
law. There was much interesting discussion
of the importance of lay information. The
group also went on record as heartily approv-
ing the proposed medical school and central
hospital for Mississippi.
As a final gesture of hospitality the hos-
tess served iced drinks.
Ten members were present: Mmes. O. N.
Arrington, B. L. Crawford, W. H. Frizell, H.
R. Fairfax, A. B. Harvey, T. F. McDonnell,
C. E. Mullins, W. L. Little, J. J. Pittman, and
R. B. Zeller
A luncheon was enjoyed with the doctors
at the noon hour, after which the ladies re-
tired for their meeting. It was voted to invite
the Pike County ladies and the State Auxiliary
president to a social meeting to be held in
Brookhaven, December 11. Plans were made
to increase the sale of Hygeia, and carry out
health programs.
The meeting was adjourned to meet on De-
cember 11.
PHYSICIAN WANTED: Physician for indus-
trial dispensary in South. Must be graduate
Class A school. Please write details and give
references in first letter. Expenses of inter-
view will be arranged for satisfactory appli-
cants. Write to Medical Director, Box 590,
Knoxville 5, Tennessee.
Quit
a
MINUTE
DOCTOR!
I know you’re rushed these days, but have
you ever stopped to think about how I am
making much of your work easier and better?
In the home or in the hospital, you’ll always
find me on the job. I’m glad to have a part
in promoting good health, and believe you’ll
agree that I am the most economical assist-
ant you have. And the best part of it all is —
we both give good service under the free enter-
prise system!
Your Electric Servant,
REDDY KILOWATT
TRI-COUNTY AUXILIARY
The Woman’s Auxiliary of the Tri-County
Medical Society met at Brookhaven on Tues-
day, September 11.
Mississippi Power & Light
Company
Helping Build Mississippi
The Mississippi Doctor
September, 1945
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Blue Cross Insurance and Medical Economics
Guest Editorial
E. D. CAREY, M. D.
Past-President of the Southern Medical and the American Medical Associations
Dallas, Texas
True democracy, serving its people in the
field of health, has been an ever colorful
parade during the past decade. The num-
ber of daily volunteers and the magnitude of
these voluntary forces are amazing and inspir-
ing.
These united forces, undeterred by opposi-
tion, have advanced into a new era in success-
fully demonstrating a modern American means
for the distribution of good health care a-
mong the multitude and at a cost all gainfully
employed can afford to pay. This force was
not created by legislation or compulsory
governmental orders. It is the force of volun-
tary action, truly representative of the Ameri-
can way of life. It has been aided by the
medical and allied health professions.
The spearhead, the Blue Cross plans for
protection against the costs of hospitalized ill-
ness, has enrolled more people in less time
than any voluntary program in the history of
the world.
This movement began as a cautious experi-
ment in the law of averages. Ten years ago
there were approximately 100,000 Americans
budgeting their hospital bills through volun-
tary, non-profit prepayment plans which of-
fered free advice of institutions. At the pres-
ent time 19,000,000 persons — nearly one-
seventh of our civilian population — are
covered by Blue Cross Plans in 43 states and
seven provinces.
Blue Cross protection is available in 3500
member hospitals which constitute 85 per
cent of the bed capacity open to the general
public for acute illnesses. The movement is
sponsored by 1500 civic leaders from industry,
labor, welfare, hospitals and the medical pro-
fession. These trustees serve without pay;
their only reward is the satisfaction of per-
forming a public service through which Ameri-
cans can place hospital care in the family
budget along with other necessities.
Blue Cross has now moved from the area
of cautious experiment to the field of coura-
geous leadership. Public acceptance has grown
441
rapidly. In addition to the 19,000,000 members
of Blue Cross Plans, an additional 8 or 10
million receive more or less complete protec-
tion through industrial medical service and
stock or mutual group insurance policies
There are now 26 Blue Cross Plans coordin-
ated with nonprofit, medically sponsored pre-
payment programs for physicians’ service. The
number of such plans is increasing each
month, and enrollment may ultimately reach
the number of subscribers in hospital plans.
The coordination of medical plans with Blue
Cross is consistent with the public’s desire
for protection against the full costs of hospi-
talized illness and with the elementary fact
that medical attention and hospital care are
interdependent factors in the diagnosis and
treatment of illness.
The policies and methods of cooperation are
in a formative stage, with different degrees
of administrative unity, which vary from
completely identical to entirely separate cor-
porations and personnel. The ultimate valid-
ity of any specific methods of coordination
must be tested by public acceptance, quality
of service, and the freedom of action and
choice provided to physicians, institutions and
patients. --
To preserve the free enterprise system in
this country, any legislation that is as far-
reaching as the Wagner-Dingell bill would
inevitably lead to a curtailment of free enter-
prize, even to the point of a managerial form
of government taking over the industries as
well as the regimentation of medical practice.
In this world evolution plays a very definite
part and the trial and error system has solved
many problems before great mistakes are
made.
The rapid acceptance of prepayment types
by industrial units and the more or less phil-
anthropic services of hospitals and medical
practitioners is preserving some of the under-
lying principles which lead to the progress of
the medical sciences and the happy attitude
of the profession towards patients, which
should be given every consideration before any
342
Blue Cross Insurance — Careiy
October, 1945
federal interierence which the medical profes-
sion believes would be harmful to this pro-
gress and a lack of such progress definitely
harmful to the welfare of the same.
No other country has made such rapid
strides in medical service. In no other coun-
try has there been the same spirit of service,
where men have given not only of their time
and talent but their money to prevent and to
cure disease. They have done this because of
their love of their profession, the pride they
have in accepting progressive accomplish-
ments and redistributing medical knowledge
among themselves for the common good. Any
invasion of medical ideals and medical will-
ingness to foster this cooperative effort would
be felt by the people who wish the best in
medical practice for themselves.
Non-profit medical and surgical programs
are now being rapidly developed in harmony
and in conjunction with Blue Cross hospitali-
zation. This adds greatly to the solution of
all catastrophic illnesses. The great insur-
ance companies now see their way clear,
through better actuarial data, to take care of
many thousands of the employed on a more
satisfactory basis for employer and employee.
Free enterprize is at work. Progress is be-
ing made. The people are the ones to be
grateful that a hurried solution of medical and
surgical service and hospitalization is not pre-
cipitated along incorrect lines.
In conclusion I would like to say that I
have always been embarrassed to be on the
negative side of any question. I iam much
happier to be an advocate of something that
seems right and progressive than to remain
static or in opposition.
There have been two or three bills introduc-
ed recently which have definite merit. The
Hill-Britton bill which would make possible
the development of hospitals where needed is
in line with the thought I expressed as presi-
dent of the Southern Medical Association in
1920. I expressed the thought that well trained
doctors would not remain in small towns
or in the country unless the city-county units
provided the necessary service for them to do
scientific work. Then there is another bill in
Congress for providing funds for research and
this is a comprehensive bill, which would make
possible research in the basic sciences as well
as support research in the medical schools of
this country.
I am advocating a comprehensive bill as a
substitute for the Wagner-Murray-Dingell
bill, taking care of these two important
measures but also supplying grants in aid for
the care of the underprivileged and the low
income group through prepayment insurance
programs, which need not require any kind of
bureau or federal supervision but through the
normal local challenge of the commissioners’
court and medical profession. The Wagner-
Murray-Dingell bill does not reach the people
who cannot afford to pay, but reaches the
people who are made to pay through taxation
and in doing so a bureaucracy is created. At
least 20 per cent of the resources collected
would be needed to sustain the administrative
phases and the political, and with this develop-
ment of a larger number of federal employees
the political signification would not be lost,
upon those remaining in office.
BLUE CROSS PLAN GROWS
Records continue to be broken in the number
of Americans joining voluntary non-profit
plans for prepaying hospital bills. A total
of 2,282,482 new members joined during the
first six months’ period of 1945 and thus ex-
ceeded by more than 500,000 the previous rec-
ord membership growth established during
the corresponding period of 1944.
This announcement was made by Dr. C.
Rufus Rorem, director of the American Hos-
pital Association’s hospital service plan com-
mission, who stated that the total Blue Cross
membership in forty-three states, the District
of Columbia, seven Canadian provinces, and
Puerto Rico now numbers 18,800,000 Ameri-
cans.
Six states have passed the million member-
ship mark. New York State leads with over
3,000,000 Blue Cross members; Ohio, 2,160,-
000; Pennsylvania, 1,933,000; Michigan,.
1,303,000; Illinois, 1,220,000; and Massachu-
setts, 1,202,000.
A state-wide Blue Cross plan has just been
approved for New Mexico which leaves only
Arkansas, Mississippi, South Carolina, Idaho,
and Wyoming without a community and hos-
pital-sponsored plan for removing the finan-
cial worry of hospitalized illness or injury.
The Treatment of Uterine Fibroids
STANLEY A. HILL, M.D.
Corinth, Miss.
IN order to toe abreast of the times I have
chosen to present, first, the treatment of
fibroids with atomic energy. In contrast to
the popular belief that atomic energy was
first utilized with the two famous bombs
dropped on Japan, roentgenologists have been
studying, developing, and improving the use
of atomic energy in the therapy of new
growths for half a century. Both the use of
x-ray and radium embrace this phenomenon.
Radium
In small bleeding submucous fibroids radium
therapy works well. Since sterilization may
result, cases where no more children are de-
sired or those cases at the menopause should
be selected. Tumors up to twelve centimeters
in diameter are considered of suitable size.
Only in patients constitutionally unfit for sur-
gery are larger fibroids to be submitted for
radiation. X-ray therapy is used but radium
is the agent of choice, 2400 milligram hours
being given as an average dosage. Bleeding
at the first two menstrual periods following
treatment is probable and sometimes excessive
in cases that are eventually cured.
Surgery
In the larger tumors involving the entire
uterine body, subtotal hysterectomy is re-
quired. The pathological anatomy may indi-
cate other procedures. For instance, if the
tumor is located low on the body and extends
onto the cervix, or is growing from the cer-
vical canal, total hysterectomy is indicated.
When the tumor is attached to the cervical
canal, grows to a large size extending into
the vagina, the seriousness of the case is
greatly enhanced. Since these bleed profusely
transfusion may be required.
Myomectomy Favors Fertility
A white patient, age 35, married nine years,
sought the correction of sterility. Two fibroids,
the size of golf balls, were found attached to
the right anterior side of the uterine fundus.
These were removed June 30, 1944, followed
♦Read before the quarterly meeting of the
Northeast Mississippi Thirteen Counties Society,
September 11, Amory, Miss.
by prompt recovery. She bore a live baby
August 16, 1945. Therefore, whenever feasible,
the writer wishes to advise myomectomy.
Complications May Prove More Important
Than The Myoma
Another white patient, age 35, underwent
laparotomy May 24, 1944, with the preopera-
tive diagnosis of fibromyomata uteri. Explora-
tion revealed the following complications in
addition to leiomyoma of the uterus: 1) severe
bilateral salpingitis, 2) endometriosis (endo-
metrial cysts of right ovary, 3) acute peri-
appendicitis, 4) extensive pelvic adhesions.
Myomectomy, bilateral salpingectomy, right
ovariectomy and appendectomy were executed.
A febrile postoperative course resulted but,
even so, the patient was able to leave the
hospital on the eleventh postoperative day.
The draggy convalescent period was accepted
as the expected sequence of events. Enthusiasm
as to good results faded when this patient
came down with acute intestinal obstruction
July 12, 1945, (about 13i months after the
first laparotomy). The right half of the colon
was involved, the blood supply having been
embarrassed by the adhesions. This was
thought to have been a complication of the
endometriosis more than the other conditions.
This may be a debatable point. Nevertheless,
she had Providence on her side and made a
prompt recovery even though the outcome
could not be predicted for three days.
Pathology
Myomas are tumors composed of muscle.
Leiomyomas are made up of smooth muscle.
Rhabdomyoma is the term referring to the
more rare striated muscle tumor.
To gross examination there may be the
several anatomical types of myomas found in
one mass. The subserous, intramural, and
submucous types according to the location
in the wall may exist in one uterus. Essen-
tially myomas are composed of smooth muscle
tissue arranged in whorls that glisten with a
tendon-like lustre. This is supported by a
varying amount of fibrous tissue framework.
On cut section the glistening tumor bulges
from its encapsulated walls. There is a poverty
444
The Treatment of Uterine Fdbroidsj — Hill
October, 1945
of blood vessels, usually a main nutrient artery
to each tumor that soon, as the tumor en-
larges, cannot supply the demand. Hence the
reason for degeneration arises. It is now ac-
cepted that myomas originate in the muscula-
ture of the uterine wall. The former belief
that they arose from the smooth muscle of the
blood vessel walls has been discarded. The
fact that myomas soften during pregnancy
and regain their hardness afterwards points
to their origin from uterine musculature.
Adenornyomata is the term applied to dif-
fuse myomas occurring at the horns of the
uterus and in the Fallopian tube itself. These
contain epithelium lined gland-like cavities. Al-
though argument has been advanced for these
being misplaced rudiments derived from the
mesonephron (wolffian body) it is now ac-
cepted that the glandular elements can be
traced directly to the uterine glands.
One of the intriguing phenomena is the sepa-
ration of a relatively large tumor nodule from
the uterus with secondary implantation into
the parietal peritoneum of the posterior ab-
dominal wall. The pedicle becomes twisted and
the blood supply gradually increases enough
to sustain the tumor. When the tumor becomes
entirely separated from the uterus it is known
as a parasitic myoma.
Degeneration
The several kinds of degeneration described
in the older textbooks result from the in-
adequate blood supply. There is one main nu-
trient artery, the others being gradually
crowded out and this one in turn overburdened.
This gives rise to the degenerative changes
as the vicious cycle progresses. The types
of degeneration will not be described more
than to comment on the fact that the sub-
mucous fibroids are especially productive of
serious symptoms. The uterus tends to expel
them into the vagina exposing the surface to
infection. Circulatory changes cause the mass
to soften and disintegrate leading to wasting
in the woman. The frequent hemorrhages pro-
duce extreme anemia. The disturbance in the
circulation leads to cardiac hypertrophy, and
a risk of cardiac failure and collapse. Other
writers call this the “myoma heart.” I have
never thought that this should be considered
a separate clinical entity but simply a reflec-
tion of the anemia and upset physiology caused
by the myoma. Having had the painful ex-
perience of losing a profoundly anemic pa-
tient on the table, i am a firm advocate of
blood transfusion. However, since there is a
tendency to overwork transfusions, may I re-
late the statement of a staff member of
the Mayo Clinic, “If a woman can walk, she
can be operated upon.” This seems to be a
rather good practical guide. If the patient
is ambulatory, she can weather a good deal
of surgical shock; if she is bedridden building
up procedures are often required.
Before leaving the subject of degeneration
malignant changes should be mentioned.
Adenocarcinoma of the endometrium, at
times, is associated with myoma. This is con-
sidered to be encouraged by the myoma act-
ing as an irritant. Therefore it is good prac-
tice to heed the teaching of Lahey and execute
a diagnostic curettage before doing the lapa-
rotomy. This will allow one to do a total
hysterectomy if carcinoma is reported.
Sarcomatous degeneration of fibroids occurs
most often about the age of fifty in cases of
long standing that have passed the menopause.
Since there is no clinical method of making
the diagnosis of myosarcoma we can only sus-
pect it in a large fibroid after menopause that
takes on sudden increase in size.
Diagnosis
The diagnosis is easy in the large uncompli-
cated types but may become most difficult
in the smaller ones either with or without
complications. The large firm asymmetrical
nodular mass that moves when the body of
the uterus is moved is typical and usually the
menstrual story may be disregarded. The small
intramural or submucous tumor that is not
large enough to be outlined by bimanual pal-
pation may not be conclusively proved until
the uterus has been removed and sectioned.
The next difficulty may be a fibroid that
could be outlined preoperatively but at opera-
tion found to be just part of the pathology.
If, as in the case reported above, severe pelvic
inflammatory disease with perhaps endometrio-
sis thrown in for good helping is found, the
moderate sized myoma may be the most in-
significant part of the diagnosis. The pa-
tient’s outlook will have to be evaluated on
the additional pathology found almost to the
disregard of the myoma. In these complicated
cases a better preoperative opinion may be
gained by doing a bimanual pelvic examination
under general anesthesia.
Although menorrhagia and metrorrhagia
coupled with pressure symptoms may strongly
suggest a myoma, the diagnosis is really es-
October, 1945
The Treatment of Uterine Fdbroidst— Hill 445
tablished by the objective palpation of the
tumor mass. This brings up another practical
point, namely, pregnancy. One may want to
know if pregnancy coexists with the tumor.
Or, if the case of a fibroid uterus that is
symmetrically enlarged the problem of tumor
versus pregnancy arises. In this situation the
Ascheim-Zondek test is the best referee. Then
one has a reliable test from which to advi^
his patient. Although few may be prepared
to make the test, one ounce of voided urine
to which a grain of boric acid has been added
as a preservative can be readily packed and
mailed to a laboratory. The result is reported
after forty-eight hours.
Ovarian cysts may at times present a prob-
lem in the differential diagnosis. The fluid
consistency, fluid wave, and lack of firm at-
tachment to the uterus will usually indicate the
true condition.
Surgical Technic
Adequate exposure and good light are fun-
damental to good surgery. The practice of
laying off the proposed incision by scratching
the skin with the back of the scalpel point and
making a few cross hatches is quite worth-
while. The cross hatches have guides for
matching the skin margin at closure. If there
are no marks left, the towel clamps and re-
tractors may have so distorted the skin as to
allow one to miss the proper approximation
from one to two or more inches.
Lahey has recently published an excellent
discussion of technique in the Surgical Clinics
of North America. The skin incision is begun
to the left of the umbilicus and joins the me-
dian suprapubic portion of the incision at a
135-degree angle. This leaves a good strip of
the rectus sheath to the left of the umbilicus
that will insure a firm closure. The pyramidalis
is exposed early and forms a natural anatomi-
cal pointer to the midline. Then the patient
is placed in Trendelenburg position and the
intestines walled off with moist packs. I have
been unable to employ the omentum as des-
cribed in the above article for walling off the
intestines but believe it worth while when an-
atomically possible. The round ligaments are
ligated and divided. Then the infundibulopel-
vic ligament is next ligated and divided at the
side of the uterus or lateral to the adnexa. This
depends on whether or not one elects to re-
move the adnexa or not. Then the peritoneum
reflected from the bladder is divided in a
tranverse plane across the cervix and the
bladder wiped down from the anterior wall
of the cervix and vagina with gauze. Careful
attention to this point will get the bladder
out of the way of the suspension procedure
after the excision of the uterus. The wiping
maneuver will usually expose the uterine ar-
teries. At this point one needs to know the
location of the ureters which form the struc-
ture most easily damaged by hysterectomy.
Although not as easily demonstrated as the
master surgeons indicate, it is good practice
to hunt for them. It is not necessary to dissect
out the ureters in subtotal hysterectomy but
may become so in total removal. After one has
satisfied himself that he will not damage either
ureter the uterine vessels are clamped, making
the nose of the clamps point into the cervix,
and two ligatures affixed.
Then the uterus is excised by amputating
across the cervix. This is best done by making
the knife strokes at a 45-degree angle to the
axis of the cervix thus removing much of
the cervical canal. Then hemostasis is secured
by placing about three mattress sutures across
the stump. I have been unsuccessful in secur-
ing firm hematosis by interposing the ends
of the two round ligaments between the lips
of the cervical stump and therefore attach
them after the mattress sutures are secured.
The infundibulopelvic ligaments are tied to
the cervical stump and all raw surfaces are
peritonized by approximating the bladder re-
flection of peritoneum to that from the rectum
with plain catgut. Frequently one stitch will
suffice. The toilet of the pelvic cavity is at-
tended to, the table flattened, and the ab-
dominal wall closed in layers.
In total hysterectomy the bladder is wiped
farther downward exposing the upper part of
the vagina which is opened in the anterior
fornix. Then the cervix can be grasped in ten-
acula and held in an upward stretch while a
circular incision divides it from the vagina
allowing the uterus to be lifted out. Although
more suturing is required, the closure of the
vaginal stump and its suspension is similar
to that described for the cervix.
SUMMARY
The treatment of uterine fibroids is largely
a surgical procedure. Submucous fibroids in
cases where sterilization makes no difference
and in the absence of complicating inflamma-
tion may be suitable to radium therapy.
Myomectomy is urged if at all possible dur-
ing the childbearing age.
446
Female Urethritis — Murfee
October, 1945
Hysterectomy for the larger tumors yields
good results. However, in the writer’s experi-
ence complications, that is, disease of the
Fallopian tubes and ovaries, are frequently
encountered which influence the prognosis
more than the myoma itself.
REFERENCE'S
1. William P. Graves: Gynecology, Fourth Edition,
W. B. Saunders Company.
2. Lippincott’s Quick Reference Book, Medicine
and Surgery, 1934.
3. W. G. McCallum: A Textbook of Pathology,
Fourth Edition, W. B. Saunders Company, 1928.
F. H. Lahey: The Technic of Total and Subtotal
Hysterectomy. Surgical Clinics North America. June
1945, pages 473-489.
Female Urethritis
JOHN A. MURFEE, M.D.
Amory, Miss.
The female urethra itself occupies only
a very small portion of the human anat-
omy. * Its length is only one to one and
three-fourths inches. Its walls are very elas-
tic and the caliber should easily accommodate
a 3 F instrument in the adult. At times the
thickness of the wall is as much as ten to
twelve millimeters. Towards its proximal end
are many small glands around its circumfer-
ence. The presence of the latter until recently
has been debated by leading urologists. Their
existence now is a well established entity,
some even becoming hyperthrophied to such
an extent that transurethral resection has
been resorted to for relief of the obstruction —
hence the term female prostate.
The symptoms produced by diseases of the
female urethra are legion and have simulated
all conditions known to arise from within two
feet of the pelvis. The patients suffering from
such troubles have been tossed about freely
in an effort to bring relief to both the patient
and the doctor for listening to the various and
sundry complaints. The gynecologist has felt
the condition to be out of his field; the
urologist has felt the condition beneath the
dignity of his knowledge and skill; the sur-
geon has removed appendices, ovaries, uteri,
fallopian tubes, and the orthopedist has even
gone so far as to do sacro-iliac and lumbo-
sacral fusions of the spine; the internist
has put in his bit to find the cause of the
trouble ; the roentgenologist has used his
small elastic tube; the psychiatrist has as-
sured these patients that a rest and change
*Read before the quarterly meeting of the North -
■east Mississippi Thirteen Counties Medical Society,
September, 1945, Amory, Miss.
of environment is all that is needed. Lastly,
that patient in her wild effort has turned to
the “cure all” chiropractor who has “adjust-
ed every vertebra in her spine” at the rate of
$2.00 per treatment, but the patient still
complains and the urine remains crystal clear
and the symptoms are varied as the colors
of the rainbow. Frequency and dysuria are
probably the two most common complaints,
but chronic granular urethritis has been known
to mimic appendicitis, salpingitis, renal and
ureteral stones, diseases of the spine, sciatica,
gallbladder disease, and various nervous mani-
festations are common.
The exact etiology of the disease known as
chronic urethritis of the female is varied,
but trauma and infection cover most of the
cases. The glandular structure of the posterior
urethra make it possible for infection to re-
main over long periods of time and have
been the foci of infection in diseases such as
furunculosis, neuritis and arthritis, critis, etc.
After the infection has been present for some
time, the surface becomes granular and be-
cause of the concomitant scar tissue forma
tion the calibre of the urethra is reduced
sometimes to the point of stricture formation.
This, of course, is capable of producing dam-
age of the kidneys, ureter, and bladder as
would an ordinary case of prostatitis from the
granulations. Sometimes, small polyps and pap-
illas form from the granulations. The inti-
mate lymphatic contact of the cervix with
the bladder and urethra make it highly de-
sirable to eradicate infection of the former
before instituting therapy for the latter. I
speak particularly of chronic cervicitis. It
goes without saying that infection in Skene’s
glands must be eradicated also, and infection
October, 1945
Female Urethritis — Murfee
447
.higher in the urinary tract, is of course, to
be looked for and treated, but the great
majority of such cases do not present such an
entity.
The diagnosis of chronic urethritis does
certainly not require the equipment nor the
knowledge and skill of a urologist. The most
useful instrument is the acorn tipped bougie a
boule. I usually employ this in various sizes
from 6 F to 14 F or 16 F in all cases of
dysuria and frequency and many other cases
where the etiology of the malady is not
clear. The instrument is well lubricated and
introduced carefully into the urethral meatus
and thus on into the bladder. Definite points
of tenderness and tightness along the course
of the urethra are thus detected and there
is usually a definite “hang” to the instru-
ment as it is withdrawn. Sounds, preferably
but not necessarily straight ones, are then
used to determine as nearly as possible the
calibre of the urethra. Normally the adult
female urethra should accomodate a 30 F
sound with ease. This is all that is necessary
the vast majority of times. Of course, if one
possesses a urethroscope of the water dilat-
ing variety, he may inspect the entire cir-
cumference of the urethra and also detect
papillae and polyps which have formed along
its course, more often close to the bladder
neck. These can be suspected by the bougie a
boule method and the symptoms, but the
positive diagnosis can only be made by direct
examination. It is to be strongly emphasized
that many of the most severe cases have urine
specimens that are crystal clear and contain
no microscopic findings.
The treatment for chronic urethritis has
been as varied as the symptoms. The bladder
and urethra have been irrigated with solu-
tions of conceivable colors, strengths, and
chemicals. Time-honored drugs such as po-
tassium permanganate, picrates, argyrol, green
soap and boric acid have been used with
little or no relief. Bromides, citrates, hyoscy-
amus, and the long famous buchu and sandal-
wood have been given orally, still with little
or no avail. Hot sitz baths have been resorted
to with little help to either patient or doctor.
The therapy of choice is gradual dilatation
with steel sounds or woven bougies followed
by increasing strengths of silver nitrate be-
ginning with a 1 to 1,000 and increasing
gradually to 1 to 100. The urethra is dilated
only one size at a sitting until a 28 or 30
F is reached. Treatments should take place
about once every week. I prefer to start each
treatment with a size smaller than the larg-
est used at the previous time and go up two
sizes. I am sure there isn’t a doctor in this
section who does not have in his office this
minimum of equipment, but judging from
the many women presenting the disease in
question I am sure the sounds have been con-
fined in their application to the strictured
male urethra. Their application to the female
is certainly worth while and the patients
-should be instructed for a check-up at times
that the physician might designate, and should
continue this over a long period of time due
to the likelihood of recurrence from the ever-
present scar tissue produced by the chronic
inflammation and infection of the urethra.
If the urethra presents large granulations or
polypi, it is usually necessary to destroy
these by fulguration under direct vision. The
relief to the patient is usually dramatic and
she will tell you she feels better when she
gets off the table.
It is beyond the -scope of this paper to
discuss the diagnosis and treatment of such
conditions as urethral diverticulum, vesical
calculus, elusive ulcers, etc., but they must
be kept in mind although they do occur much
less frequently than the urethritis.
Beauty lurks beneath the surface of all
people Find the beauty that is inside
of you and remain true to it, in dress, in
action and even in thought. That, I believe,
is the secret of all real beauty.
— Katherine Cornell
Recent Advances in the Medical and Surgical
Management of Gallbladder Disease
7 o. B. CROCKER, M.D.
Bruce, Miss.
The management of gallbladder disease
once the diagnosis is established is not
always obvious or clear cut. One is con-
fronted with many problems. Is it a medical
or surgical problem? If medical, what plan
of therapy should be instituted? If surgical,
is it an emergency or may one prepare the
patient and operate at the most opportune
time? These are some of the questions that
always occur. I shall try very briefly to give
you the concensus of opinion in the best
clinics of the country regarding these problems
at the present time.
In any discussion of the medical treatment
of gallbladder disease one must consider that
there are no procedures which can be uni-
formly applied to every patient and any ef-
fort which requires adherence to routine pro-
cedures will meet with failure because the
individual variations in patients are not con-
sidered.
For convenience we shall divide the gall-
bladder diseases into five main varieties.
These are: the so-called group of biliary dys-
kinesias, chronic non-calculous cholecystitis,
calculous cholecystitis without colic, calculous
cholecystitis with colic, and acute cholecysti-
tis with empyema.
Biliary dyskinesia is a rather indefinite
diagnosis. It is a diagnosis which is based upon
the presence of vague gallbladder symptoms,
vague bowel symptoms, no history of colic, and
the finding of poorly filling or poorly empty-
ing gallbladders on roentgenologic examination.
On physiologic grounds it seems as reasonable
for an individual to have spasm of sphincter
of Oddi as it does for an individual to have
spasm of the pylorus or to have bowel spasm.
From the standpoint of management of these
individuals, they should respond ideally to the
use of anti-spasmodics, a high fat, bland
diet, and the administration of bile salts.
Chronic non-calculous cholecystitis, it is gen-
erally believed, is primarily a medical problem.
*Read before the quarterly meeting of the North-
east Mississippi Thirteen Counties Medical Society,
September, 1945, Amory, Miss.
In an occasional case the symptoms may be
relieved by cholecystectomy but in general
these patients do not obtain good results from
operation. This group includes particularly
those patients who have a vague type of
dyspepsia and abdominal discomfort but who
have not had biliary colic and do not have
positive cholecystographic evidence of disease.
This group of patients should be treated con-
servatively. They should have a bland diet,
with uncooked fats allowed up to the point
of the individual’s tolerance, the use of anti-
spasmodics and the use of bile salts.
The third group of patients are those who
have cholecystitis with calculi but without co-
lic. These usually are individuals in whom the
stones may be discovered during the course of
some other examination or who have a large
single solitary calculus within the gallbladder
which remains quiescent and produces little
in the way of symptoms. There is a wide
diversity of opinion about the proper proce-
dure in this type of case. The surgeon points
to the carcinomas of the gallbladder that are
practically never found except with stones
and the internist points to the fact that post-
mortem statistics show that 25 to 30 per
cent of all persons more than sixty years of
age have chronic cholecystitis with stones.
From the standpoint of management of these
patients as medical problems, there are a-
bout three considerations which must be borne
in mind: the older the patient gets the greater
is the mortality should surgery become neces-
sary. Many of these individuals, however, have
no symptoms and the gallbladder lesions are
discovered as incidental findings on post-
mortem examinations when death is due to
other causes.
The second consideration is that not a small
proportion of these individuals will develop
complications such as fistula between the gall-
bladder and adjacent viscera as the result of
pressure erosion by the large stone. The last
consideration is that there is an increasing
weight of evidence that as mentioned before
that perhaps carcinoma of the gallbladder
occurs more frequently in stone-bearing gall-
October, 1945
Gallbladder Disease— Crocker
449
bladder than in others. From the standpoint
of medical management, if an individual has
no symptoms he would not be very amenable
to suggestions of a cholecystectomy. Conserva-
tive management would entail periodic super-
vision together with a management which
would tend to keep the individual out of troub-
le. Such measures would consist of efforts to
prevent spasm through the constant use of an
anti-spasmodic; efforts to regulate bowel ha-
bits through the use of a bland diet so as to
prevent any reflex spasm of either bowel or
common duct sphincter; and lastly, careful ad-
justment of the uncooked fat content of the
diet so as to prevent unnecessary gallbladder
stimulation. The next group of individuals
who have gallstones and who have frequent
or repeated attacks of colic, it is generally a-
greed, should be subjected to cholecystectomy.
They may be temporized for vague and in-
definite periods of time by medical procedure
but by and large ultimately surgical removal
of the gallbladder will be the only means of
permanently achieving relief.
The principles involved in the medical treat-
ment of gallbladder disease as practiced most
consistently today can be briefly summed up
as follows :
1. Prevention of spasm — this is achieved
through the use of anti-spasmodics in which
the chief reliance should be placed on atro-
pine or atropine derivatives such as bella-
donna. Some of the synthetic anti-spasmodics
such as pavatrine or transentine have an in-
determinate value. Spasm can further be pre-
vented by the control of diet. Usually as-
sociated with gallbladder disease there are
manifestations of bowel irritability. Cathar-
tics should be avoided. A bland diet with un-
cooked fat should be given.
2. Facilitation of gallbladder emptying is
the second principle of management to be
achieved. This is accomplished both by the
prevention of spasm and the supplemental ad-
dition of uncooked fat. If the fats are cooked,
the fat is oxidized from neutral fat to fatty
acids, in which form it acts as a gastric ir-
ritant.
3. The third factor consists of efforts to
increase the flow of hepatic bile through the
use of bile salts which acts directly on the
liver cells.
These principles of management, you will
note, differ from the longstanding, widely
used low fat, low cholesterol diet associated
with the administration of magnesium sulfate
or other saline cathartics. The newer regime
as outlined certainly is more physiologic in
principle.
The last type of gallbladder disease, acute
cholecystitis with empyema with or without
stones, comprises about 20 per cent of all
diseases of the biliary tract encountered in
medical and surgical practice. Its management
is controversial. The most widely argued point
is whether operation should be delayed. It is
pretty generally agreed now that these acute
cases if possible, should be operated on in
the first twenty-four to forty-eight hours fol-
lowing the acute attack. If the patient is
elderly or for any other reason a very poor
risk, the chances of survival may be better
if the acute phase is treated conservatively
and the operation done at some future time.
If the operation is performed within forty-
eight hours of the attack, it is usually not
difficult or hazardous. The tissues are edema-
tous but have not yet become indurated and
friable. The risk of peritonitis is negligible.
It is usually possible to carry out classical
cholecystectomy without difficulty, the edema
in the tissue controls the oozing and results
in an excellent line of cleavage for the dis-
section. It is estimated that if operation is
delayed perforation will occur in about fifteen
per cent of the patients. The dangers of such
a complication are well known. If on opening
the abdomen the condition is such that a
removal can’t be done, cholecystectomy may
be done with relatively little risk and removal
at a later date if necessary.
Every normal man must be tempted, at
times, to spit on his hands, hoist the black
flag, and begin slitting throats.
— Mencken
State Committee Favors Four- Year
Medical School
Report of Committee on Medical Education, Mississippi State Medical Association
The Committee on Medical Education for
the Mississippi State Medical Association real-
izes the need for more and better hospitals
and more and better physicians in the state.
Briefly, our recommendations are as follows:
First: That the private hospitals which now
receive state aid for their charity departments
should continue to receive the same amount
of aid, or more.
Second: That it would be wise to have ap-
pointed a non-political board of trustees to
manage the hospitals of the state, which are
owned by the state or state aided. This com-
mittee could receive very material assistance
from the Federal Government in promoting
better hospitalization for Mississippi.
Third: A hospital without adequate medical
staff is unable to give the best medical care
to patients admitted, and the number ad-
mitted is limited.
Fourth: The Committee believes that in or-
der to have an adequate supply of well train-
ed physicians provision should be made in
the state to train these physicians.
Fifth: It is the opinion of this Committee
that it would be expedient for basic sciences
in the medical school to continue to be taught
in the University, as they have been in the
past, and we feel that facilities of the Univer-
sity should be enlarged so that fifty freshmen
a year can be admitted to the school and pos-
sibly after one and a half years these students
should be transferred to the clinical depart-
ment of the medical school; the clinical depart-
ment of the school should be established some-
where in the state where the most adequate
clinical facilities may be found, which will ne-
cessarily be in a larger city.
Sixth: That it will be necessary to have a-
bout a three-hundred-bed central teaching
hospital connected with the medical school,
the management of which would most probably
best be under the Board of Trustees of the
Institutions of Higher Learning.
We submit the following evidence to sub-
stantiate these opinions.
The Committee on Medical Education of the
Mississippi State Medical Association has am-
ple proof of the need for more medical care
for the people of the state, and in order
to have more medical care, the services of
more physicians year by year will be required.
More hospital facilities are needed, but what
will it profit us greatly to increase hospital
facilities and not have physicians to work in
those hospitals?
Only last month our part-time health of-
ficer in Carrol County died. A physician was
selected to fill out his unexpired term, and
the youngest of the four physicians left in
Carrol County was appointed. He was 65
years old October 7, 1945. This situation ob-
tains in a number of our counties. We have
entire counties with from one to three or
four physicians with an average age of sixty-
five years or over for the physicians. They
will all be dead, or at least inactive, within
a few years, and Mississippi must plan to fill
the gaps or the people will suffer even more
chan they suffer now.
The recent survey showing the number
of physicians in Mississippi by counties, race,
and average age is self-explanatory, and should
impress any thinking Mississippian with the
gravity of the situation.
The following letters are but samples of
many letters received.
July 18, 1945
“For some time I have watched with much
interest the fight being waged for a four-
year medical school in Mississippi. I have had
a strong personal interest in the question be-
cause I am wondering when and from what.
source are younger shoulders coming to lift
from my own overburdened shoulders a load
that has at many times been almost more
than I could carry. At the beginning of World
War II, there were four physicians in Frank-
lin County. Two left early in the war and my
colleague, Doctor Costley, and I have had
to look after the medical needs not only of
Franklin County, but also of that territory of
Amite and Lincoln counties which immediately
touches Franklin. And, we haven’t been so
situated that we could strike for shorter
hours and bigger pay! I could shoulder the
450
October, 1945
Report on Medical Education
451
load with more confidence and courage if
I could see any relief coming, but frankly
I can’t.
“Our government pursued a very short
sighted policy in the beginning when it did
not provide facilities for medical students for
all young men who were ready for medical
school. I personally know of two young men
in thi-3 county who had completed pre-medicai
work and wanted to pursue their studies. How-
ever, the draft boards said to them that they
must be accepted by an ‘A’ grade medical
school within a prescribed time limit in order
to be deferred. Every ‘A’ grade school to
which they applied for admission answered
that its quota was filled for one years, so
these two young men enlisted and today are
serving in foreign theaters of operation.
Temporarily they were lost to the medical pro-
fession which so much needed them. I am
told that there were many similar cases.
“Mississippi has always prided itself on its
fine medical program, a program for public
health that has won national recognition. The
weakest point in that program is the lack
of facilities for complete medical education
in our own state. Mississippi is in fine finan-
cial circumstances. Now, how long will we
quibble about this important question while
our boys go elsewhere to study and too often
to locate?
J. C. McGhee, M. D.”
“September 19, 1945
“I am writing you in the interest of humani-
ty. First, I want to give you a picture of the
situation in the medical profession at Pica-
yune.
“Two or three years ago Doctor Goss, who
was twelve miles northeast of Picayune,
moved to Lumberton. Doctor Horne, eight
miles north of Picayune and who is about
seventy-five years old, is now in Touro In-
firmary. Doctor Plunkett is around seventy
years old and does make calls either day or
night. Doctor Kellis is retiring to his farm
north of Meridian. That only leaves Doctor
Northrop to do the surgery at the hospital,
and Doctor Woodward and myself to do the
practice for about 12,000 people, six or seven
thousand in Picayune and the balance in a
radius of about fifteen miles of Picayune.
“It will be impossible for Doctor Woodward,
who is about sixty-five years old and myself,
who will be seventy-one next month, to keep
up this work. We have raised a young doctor
in this community, who is Dr. G. B. Stewart
and who is now finishing his work at Touro
Infirmary in New Orleans. He has always in-
tended to locate here, and we need him badly.
“Will you please see Colonel Long and try
to, aid us in getting Doctor Steward here.
Thanking you for anything you can do for
us in this matter, in keeping Doctor Stewart
from having to go into the army.
N. W. Fountain, M.D.”
These two letters happen to be from Pearl
River and Franklin counties. There are a
number of counties no better off than these
two counties and some worse off. For instance,
Issaquena County has only one physician in
the county, Dr. W. H. Scudder of Mayersville,
who was eighty-four years of age on Septem-
ber 18, 1945.
Arkansas, Louisiana, and Tennessee have
one of three standard four-year medical
schools. We quote state population, number
of physicians, and ratio of physicians per
population :
Arkansas
Population Physicians Ratio
1,949,387 1806 1 physician per
1079.3 popula-
tion.
Louisiana
Population Physicians Ratio
2,363,880 2601 1 physician per
908 popula-
tion
Tennessee
Population Physicians Ratio
2,915,841 2961 1 physician per
984.7 popula-
tion
While Mississippi without a four-year medi-
cal school has one physician per 2,200 popu-
lation.
Alabama officially opened a four-year medi-
cal school October 1 at Birmingham.
Call the doctor — Familiar words, and of-
ten signifying a personal or family crisis, re-
quiring the best in medical or surgical skill.
More than a million times a year someone
in Mississippi calls the doctor.
What are the medical needs?
Illnesses — Over a million people were sick
some time during last year in our state.* Of
these thirty-five thousand were chronically
452
Report on Medical Education
October, 1945
ill continuing through the whole year. Others
had more acute shorter illnesses or were sick
part of the time from such conditions as
malaria 25,094;* ** pellagra 2752, syphilis 16,-
652; tuberculosis 1600; accidental injury 50,-
000; confinement at child birth and abortion
47,905; whooping cough 12,716; measles 9,-
172; pneumonia 16,288; influenza 82,770;
while colds and minor ailments of stomach,
kidneys, or intestines certainly ran to the
hundreds or three hundred thousand persons.
Defects — Today and on any particular day
there are 50,000 people in our state who are
totally or partly disabled by maiming or crip-
pling defects — 4200 blind,*** 10,000 with
serious eye defects; 765 totally deaf and dumb;
there are 6,000 crippled children,**** and
6,000 seriously crippled adults, and 35,000
partly crippled children and adults.
The physically unfit
Selective Service Rejections — Another type
of measurement of physical disability results
from the medical examination of large num-
bers of young men and women in connection
with the military service, and rejection is
not based simply on the presence of a disa-
bility but upon its severity with respect to
ability to engage in combat duty. From May,
1942, until February, 1945, local examining
boards and induction centers were compelled
to reject for health reasons the following
numbers of our young men: nervous and men-
tal diseases 23,500; genitourinary and vener-
al diseases 13,700; musculo-skeletal deformi-
ties 13,200; vision defects 7,350; hernias 7,-
250: heart inadequacies 6,150; lung conditions
(nearly all tuberculosis) 3,700; hearing limi-
tations 1,900; and miscellaneous 7,100. More
than 80,000 men from this state, who could
have filled more than five army divisions,
were physicially unfit.
Borderline Deficiencies
People in Poor Health — In civilian ranks,
in addition to the dead, the disabled
and the physically unfit, there is still another
large and important group; in fact the one
in which most of us are likely to be. A huge
group of people who are alive and apparently
undamaged but who are not in abundantly
good health, are below par in strength and
endurance. The happiness of complete well-
* Estimate basis on National Health Survey, 1930.
** From State Board of Health Morbidity Reports,
1943.
*** From State Blind Commission, 1945.
**** From Avocation Rehabilitation and Crippled
Children Service Report, 1944.
being is denied them. Their morning begins
with a lack of zest, and afternoon finds them
over-fatigued. The number is countless but
most of the people of the state are in this
group occasionally and many are in it all
the time. It is this group that we mean when
we say that 750,000 people have defective
nutrition; 1,200,000 have poor teeth, 20,000
have poor hearing; 50,000 have poor vision
and hundreds of thousands who are “soft”
for lack of exercise.
Economic Implications — All this wastage
of human beings by death, disability, and de-
ficiency is reflected in medical bills, hospital
bills, lost incomes, poverty, government re-
lief, orphaned families and broken homes.
The farmer loses his crop, the planter is
short of labor, the factory struggles with ab-
senteeism, and the armed forces require more
and more young, the aged, and the essential
worker. There are losses of farm products,
factory output is lowered, a war may be pro-
longed; in short, life is made harder for all.
Accurate computation of the economic losses
is impossible, but their magnitude staggers
the imagination. To estimate the annual
health and sickness bill (together with lost
income therefrom) drains from the people of
Mississippi, $50,000,000 to $75,000,000 would
be very conservative. This figure roughly
equals the total tax revenue of the State
government.
Conditions have changed for medical prac-
tice since 1900.
Financial Considerations — Since 1900 the
amount of time required to secure a medical
education has been lengthened from approxi-
mately three years to approximately nine
years; the cost of medical training has risen
in proportion.
Medical Education Requirements
In 1900 three or four six-month terms at
a college, no pre-medical or two to four years
apprentice with private physician were requir-
ed. The cost was from 0 to $2,000.00.
V
1945
Four years in a medical school (9 -month
terms) $5,000
Four years pre-med 4,000
One to two years internship 1,000
Total $10,000
Age of Physician at Graduation
In 1900 a boy entered at 18 to 20 years of
age, graduated at 20 to 24 years of age, and
married at 25 to 30 years of age.
October, 1945
Report on Medical Education
453
1945
Enters from 18 to 20 years of age.
Marries from 32 to 35 years of age.
Financial Status of Medical Graduate
In 1900 office rent was $10.00 to $50.00
(month), furniture $25.00 to $50.00.
Medical equipment in 1900 was one horse
($100.00), one pair saddle bags ($15.00), one
medical bag $10.00), instruments for diagno-
sis and treatment ($25.00 to $100.00).
1945
Office Space — Rent $25.00 to $50.00 (month). Fur-
niture $100.00 to $250.00. Telephone, heat, lights,
water, $15.00 to $25.00. Maid service $25:00 to $50:-
00: Secretary $75.00 to $150.00 (month).
Medical Equipment — 1 automobile $1,000. X-ray $2.-
000. Examination table $50.00. Diagnosis instru-
ments and treatment equipment $100.00 to $500.00.
Medical bag $25.00. Books, medical dues, $100.00 per
year.
In 1900 beard and room were $30.00 to
$50.00 per month. A medical graduate had
little or no debt. Financial income from
practice was $100.00 to $200.00 a month. The
cost of establishing a home was from $600.00
to $1,000.00 per year.
1945
Personal Maintenance — Board and room $70.00 to
$150.00 (month). Operation of automobile $75.00 to
$150.00 (month).
Marriage — Cost of establishing a home $1,500.00 to
$3,000.00 per year.
In 1945 a new physician finds it necessary
to have a financial income of at least $3,000
each year. For this reason it is necessary
for him to attempt to find a location which
will produce this amount.
Where do the Mississippi doctors come
from? Well, of the 1112 now practicing in
the state, 846 or nearly 80 per cent were born
in this state. During the past 20 years over
3,000 Mississippi boys have finished medicine
in more than a dozen medical schools in other
states. Less than 40% came back to practice
in Mississippi. Many physicians select the
location for practice while completing the in-
ternship in a hospital and usually locate near-
by. Mississippi has no facilities for internship
so that we lose contact with the young doctors
at this critical period and lose many doctors
for this reason.
Lack of opportunity for Mississippi boys to
learn medicine — Except for about 25 boys
each year who enter the University of Missis-
sippi, two-year medical school, all others must
seek entrance in other states; and all must go
to other states for the last two years of medi-
cine, for internship, and for the training in
such medical specialties as surgery, pedi-
atrics, etc. During the past four years the
University of Mississippi has been compelled
to reject 102 Mississippi boys as medical
students as no accomodations could be provid-
ed in Mississippi for them to study medicine.
In the horse and buggy days a physician
could keep in his office and carry in his medi-
cine bag most of the essentials for the practice
of medicine. Now, scientific progress has
given him a wonderful new set of equipment
and medical aids ; „.in fact, modern medicine
often depends on a number of especially train-
ed people in addition to the doctor. At one
time the pill bag was adequate, but now a
drug store and pharmacist are needed. At
one time many very sick people were cared
for at home with the help of sympathetic
neighbors. Now, the hospital with trained
nurses and other trained people can give the
patient better care. The microscope and lab-
oratory to help in diagnosis are essential to
good practice. Often x-ray, radium and other
very expensive equipment is needed in diagno-
sis and treatment.
When will there be more doctors in Mis-
sissippi? Some have thought that the short-
age of doctors would be over as soon as the
war ended and our doctors returned. Some
factors indicate that this is not true. We need-
ed to look over at the supply from 1909 to
1940 (prewar). We lost 612 doctors out of
2054. so that only 1435 remained. And note,
this was in peace time! Another factor is
age. In 1909 the doctors of Mississippi aver-
aged about 45 years of age. In 1940 they
averaged 55 years of age, and 388 were over
05 years of age. Death and disability are so
great in the upper age group, that the actual
loss of available medical care is even great-
er than the total number of doctors left would
indicate. As to this shortage of doctors be-
ing made up by war veterans returning, there
were 218 who left Mississippi and while they
have been away, 208 doctors have died so
that if they all return we will be fairly up
to 1200 total, including the upper age group.
In fact, all of them will not return. Some
may stay in the army. Some have been kill-
ed. Some may enter veterans hospital ser
vice, and others may enter other government
service.
454
Report on Medical Education
October. 19^0
Mississippi should at once make provisions
for four years of medicine and one year, at
least, of internship. If medical education
could be provided in the state, it would enable
Mississippi boys and girls to enter medicine,
and adequate internship would enable young
physicians to enter practice in this state. It
is while engaged in the internship that the
young doctor usually looks for a place to set-
tle down, get married, and practice medicine.
Mississippi is in urgent need of more phy-
sicians, and the Committee sincerely believes
a standard four-year medical school will, in
the vears to come, assist materially in meet-
ing that need. The Committee believes that
Mississippi ?s amply able to provide a medical
school and to improve the hospital system
for the state now. A teaching hospital is es-
sential to the operation of the medical school.
The building of the medical school and teach-
ing hospital will not be recurring expense.,
They both will stand for a half century or
longer and serve Mississippi’s medical needs.
The building of a hospital in carefully se-
lected places on the basis of need over the
state and with remodeling additions, and other
improvements to existing hospitals over the
state, with state and federal aid, is consider-
ed desirable and necessary.
Mississippi is rapidly industrializing and is
taking high place as on oil state.
The Committee sincerely believes that the
state is amnlv able and will be more able in
the vears to come to provide adequate main-
tenance for the medical school and the state
hospital system. It is believed that funds and
foundations will be interested in helping us
as they have done in most other states, but
we do not have to count on that in order
to get along.
We consider health, education, agriculture,
industries, and highway building basic and
fundamental in Mississippi’s future. There has
been a definite lag in medical care and hos-
pitalization. This seems an appropriate time
to take un the slack and to continue our
splendid efforts in the other fields. We think
we should have an A-grade school, or no
school.
H. R. Shands, M.D., Chairman Committee
Medical Education, State Medical Associa-
tion.
Felix J. Underwood. M.D., Vice-Chairman
Committee Medical Education, State Medi-
cal Association.
EDITORIAL COMMENT
Every person interested in the betterment
of himself and his state and nation should
read the foregoing report by the committee
on medical education and study it with a
mind open to the truth. Mississippi with its
many well-distributed hospitals has the basis
for the very best and most practicable medical
school in the United States. Common sense
and atomic bomb science make decentraliza-
tion still more urgent. Half the internships
should be served in the small hospitals like
we have all over the state.
You have heard it said that having a medi-
cal school in a state will not increase the
number of doctors in that state, but this re-
port shows how untrue is this statement.
Medically speaking, we are feeding the cow
whose milk and off-spring go to other states.
If all other Southern states can have one
to three medical schools, why can not Mis-
sissippi have one? Why does Virginia have
so much interest in our not having a medical
school ?
Mississippi should educate enough men for
her own state and many more fine men who
have a professional mind, a medical soul, and
a missionary heart, to go out and bless the
world with democratic medicine.
The United States is to be the mecca of the
world in medical education, and more facilities
are needed for taking care of more students.
We should quit putting a grasshoper esti-
mate on ourselves. The Israelites wandered
in the wilderness for forty years and all died
but two because they refused to believe they
could do a big job in the interest of humanity.
It is high time to quit share-cropping in
medical education and to secure some first-
class ‘ operating equipment.
The cream of the practice in medicine in
Mississippi goes to the centers with medical
schools, and this is the main reason we do
not have money at home to pay our doctors.
It will not be different until we have our
own school and extend medical service out
to the people as farm service is being carried
out to the corn and cotton field.
October, 1945
Editorials
455
The Mississippi Doctor
Published monthly at Booneville, Mississippi
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 187u. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
Official Organ Of
Mid-South Postgraduate Medical Assembly
Mississippi State Medical Association
W. H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
Mid-South Postgraduate Medical Assembly
c.
Officers :
H. Lutterloh, M. D
J.
Hot Springs. Ark.
C. Pennington, M. D
. President-Elect
L.
Nashville, Tenn.
S. Nease, M. D
. Vice-President
Newport, Tenn.
John Archer. M. D
. . Vice-President
Greenville, Miss.
John A. Moore, M. D Vice-President
El Dorado, Ark
Al. F Cooper .....' Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy. M. D Director of Exhibits
Memphis. Tenn.
Editors :
Fay H. Jones, M.D. E. M. Holder, M.D.
C. R. Crutchfield, M. D. C. M. Speck, M.D.
H. King Wade, M. D. F. M. Acree, M.D.
Mississippi State Medical Association
Editor
Lawrence W. Long, M.D.
Associate Editors
J. G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D.. Suite 412 Standard Life Building,
Jackson, Mississippi.
Dr. Cary's Article
You will read with interest and profit the
guest editorial from Dr. E. H. Cary of Dallas,
Texas, on Blue Cross insurance and on medi-
cal economics and medical legislation. This
article is so timely and worth while the points
he makes may well be emphasized.
Dr. Cary has been the outstanding leader
in the United States on sound medical eco-
nomics. We believe that the medical profes-
sion of our country may follow him safely.
We trust that we may have more from his
pen for our readers, especially on the bill that
he will endorse in Congress. From his sum-
mary:
“I have always been embarrassed to be on
the negative side of any question. I am much
happier to be an advocate of something that
seems right and progressive than to remain
static or in opposition.
“There have been two or three bills introduc-
ed recently which have definite merit. The
Hill-Burton bill, which would make possible
the development of hospitals where needed.
Then there is another bill in Congress which
provides funds for research. This is a far-
reaching bill in support of research in the
sciences. Medical schools will be definitely
supported to carry forward research.
“I much prefer to advocate a comprehen-
sive bill as a substitute for the Wagner-Mur-
ray-Dingell bill. I would include in this bill
the better features of these two bills, sup-
porting public health along rational lines and
utilize a similar plan of grants-in-aid which
is now being used for rehabilitation in the
various states.
“The Wagner-Murray-Dingell bill does not
reach people who cannot afford to pay, but
attempts to care for the people who can and
will have to pay through taxation. A prop-
er use of grants-in-aid, for those in need,
matched in part by the Commissioners’ Court,
and approved by a member of the medical
profession would simplify the cost of medical
care, placing the responsibility where it should
be and save the country from political medi-
cine. No one doubts that the Wagner-Murray-
Dingell bill would create a bureaucracy diffi-
cult to supplant, and an added burden to the
taxpayer and finally to the sick.”
The Southern Medical Association is again
holding its annual session in Cincinnati,
November 12-15, inclusive. It met there year
before last and the meeting was a good one.
The Southern Medical deserves much credit for
its part in keeping medical information flow-
ing in liquid form and without rationing for
the duration. There is really no greater medi-
cal organization in the world than the South-
ern.
456
Editorials
OeLober. 19^o
Dr. Edward Vernon Mastin of St. Louis will
preside as president, having succeeded to this
high office on June 1, following the death of
Dr. Edgar G. Ballinger of Atlanta. Twice in
succession a vice-president has succeeded to
the highest honor in the gift of the Associa-
'x tion.
Dr. Mastin was born in Mobile, Alabama,
June 13, 1891. He is a graduate of the Univer-
sity of Pennsylvania Medical School. He
comes of distinguished medical stock, being a
great-great-grandson of Dr. Ephraim Mc-
Dowell of Kentucky. He completed his fellow-
ship in surgery at the Mayo Clinic after serv-
ing in World War I. He holds a commission as
colonel in the Medical Reserve Corps, U. S.
Army, inactive. He is a very able, versatile
man with a commanding and very pleasing
personality.
OFFICE SPACE FOR RETURNING
PHYSICIANS
Among the most serious of the problems
confronting the returning physician, as is al-
ready apparent, is the difficulty of securing
suitable office space. In large communities,
such as cities of over 100,000 population, the
problem is apparently far more serious than
in the smaller areas. In some larger cities
physicians are even remodeling old houses in-
to office space. At a meeting of the board
of trustees of the American Medical Associa-
tion in Chicago, members of the board suggest-
ed that civilian physicians who have not been
in military service be urged to offer avail-
able time and space, at least temporarily, to
phvsicians who return from absences of two
or three vears in the service. Manv a physician
whose office is not fully utilized either in the
morning or in the afternoon or even in the
evening can make available time and space, as
well as the use of his own hospital staff.
This will enable the returning physician to
get in touch with those whom he served
previously and to begin rehabilitating him-
self in the practice of medicine before he
has made a permanent choice of a location.
The medical profession owes a large measure
of gratitude to the 60,000 physicians who
have given of themselves so freely and who
have sacrificed so much for all of us. The
least that can be done for such veterans is to
make available to them an opportunity to begin
the earning of a livelihood at the earliest
nossible moment. Federation Bulletin, Septem-
ber, 1945.
The North Mississippi Medical Society held
its semi-annual meeting on the University
campus, October 23, with a specially arranged
program by the Mississippi State Board of
Health and the Tulane University of Louisiana
School of Medicine. Dr. Ira B. Seale of Holly
Springs presided as president and Dr. A. H.
Little of Oxford, secretary.
Dr. Edward L. King, head of the Depart-
ment of Obstetrics, Tulane University School
of Medicine, was speaker on obstetrics, while
Dr. Ralph V. Platou, head of the Department
of Pediatrics, Tulane, lectured on pediatrics.
Dr. Howard of the State Board of Health was
present. Occiput posterior, breech presenta-
tions, obstetrical analgesia, and toxemias of
pregnancy were among the subjects discussed
by Dr. King; and the premature infant, failure
to gain, acute exanthemata and rheumatic
fever were ably expounded by Dr. Platou. The
meeting opened at two p. m„ and ended at
eleven p. m. At six o’clock at the University
cafeteria dining room, a nice steak dinner was
well served and enthusiastically enjoyed.
The university students attended the lec-
tures and many visitors from outside the
North Mississippi Medical Society.
This intensive course of lectures covered the
field about as well as we used to get in an
expensive month in New York. These short,
intensive, well-planned lectures are the order
of the day. A health center in every county
which arranges a day and night by able
consultants each month would mark a wise
advance. Consultants from our own four-year
medical school, or from Tulane, Memphis, or
Vanderbilt, might come at intervals for a day
and all doctors of the locality could bring
their difficult cases in for examination and
consultation. At the close of the day the cases
might be discussed by both the consultant and
practitioner, to the benefit of both, while the
patient is best served. Such a plan would mean
good medical economy for everyone concern-
ed. The time is urgently at hand for this
type of service to get underway. In the
meantime the State Board of Health, Tulane
University and the Commonwealth Foundation
are to be congratulated on the fine work they
are doing, as demonstrated by the program at
Oxford.
It is always nice to visit Oxford and our
University. This great democratic institution
stands for thorough work.
Some very familiar faces were absent from
this society meeting, Dr. P. W. Rowland of
October, 1945
Editorials
457
Oxford, who was the first to use oxygen post-
nasally and who did such a fine work in build-
ing a fine medical library, a past-president
of the Mississippi State Medical Association
and the Mid-South Postgraduate Medical As-
sembly, and Dr. R. M. Adams of Ripley who
was also a past-president of the Mid-South
and one of Mississippi’s most versatile and
most able practitioners, were greatly missed.
A number of the old standbys in this society
were present, Dr. B. S. Guyton, one of the able
and choice spirits of Mississippi medicine, Dr.
John Culley, an outstanding surgeon in the
mid-South, and Dr. A. H. Little, a leader in
internal medicine, Dr. Phillips, one of the level
headed practitioners of the county, Dr, C. M.
Murry of Ripley, a familiar and faithful figure
in this society as well as the state.
We offer our congratulations to the North
Mississippi Medical Society for so excellent a
program and day of fellowship.
HOSPITAL-MINDED
The general public is rapidly becoming more
hospital minded. In one year the hospi-
tal population in the United States
increased three million, enough for one
new 732-bed hospital every day in the year.
The people are realizing that as a rule the
really sick patient can be treated better and
more economically in the hospital. Mississippi
has the lowest number of bee’s per person in
the union, but it makes up in having a fine
distribution. Nevada seems to have the greatest
number of beds -per person of any state, but
not well distributed. It seems significant that
this state has the highest death rate from
appendicitis of any state in the union. The
per capita distribution of funds for the in-
digent sick is the biggest step forward yet
made for the small town and rural communities
in taking care of the sick. Without this it
v/ould be very hard for some of the smaller
hospitals to survive. The fine distribution of
hospitals in Mississippi will soon serve greatly
to hold the population in the small town
and rural communities. Eighty-five per cent
of the people continue to get sick and die of
the ordinary commonly known diseases, most
of which can be treated in the small hospital.
After all, a hospital system should follow very
largely the gradation setup of a system of
schools — grammar school, high school, junior
college, college and university. It is poor econ-
omy for children to travel too far back and
forth to school. It is better economy for a
mail carrier to carry the daily mail to a
thousand people than for a thousand people
to journey daily to the county post office to
secure it. Medical service must be carried to
all the people and largely through a graduated
and an affiliated system of hospitals. And as
teachers are the most important part of the
school, so the doctors behind the hospital, be-
hind the treatment of the sick patient, are
most important.
CANCER
Cancer takes the life of one person out of
six in America. Thirty to fifty per cent of
these lives could be saved just with the facts
we now have in hand. Cancer is not inherited
as far as medical research has thus far de-
termined. The public must be educated to go
to the doctor and the doctor must be prepared
with office equipment and trained nurse to
make every examination. A central hospital
in the state affiliated with the small ones in
which the nurses in training and the interns
should spend at least six months of their time
could help to cut down this terrible human
toll of life. Seventeen million people who are
now living in the United States will die of
cancer. For every practitioner a trained nurse
— preferably a nurse who has had training
in a small hospital and some time in the prac-
titioner’s office — would change this picture
greatly.
As an aid in making examinations and as an
educator of the public, the nurse has unlimit-
ed opportunities. When the medical leader-
ship of the profession gets away from big
hospitals and comes to earth in the real field
of medical service recognizing the small hos-
pitals as aids, we can do big things.
Every doctor and every person in the coun-
try who can should send five dollars to the
American Cancer Society, 350 Fifth Ave., New
York 1, N. Y., for membership so as to help the
cause against this killer of human beings, so as
to keep informed on what is going on in the
field of investigation, in treatment, and cure.
The December meeting of the Northeast
Mississippi Thirteen Counties Medical Society
will be held in Tupelo. We are glad to go
back to Tupelo for our fourth quarterly meet-
ing as usual. Tupelo is centrally located and
it knows how to give splendid entertainment
Let us make it a record meeting.
( continued on page 465)
458
News and Comment
October, 1945
News and Comment
DR. E. VERNON MASTIN
Saint Louis, Missouri
President, Southern Medical Association, 1945,
which holds its annual meeting in Cincinnati,
Ohio, November 12-15.
DR. F. F. YOUNG
Mississippi physicians and laymen over the entire
state learned with reg'ret of the death of Dr. F. F.
Young, founder and medical director of Fenwick
Sanitarium, Covington, La., for more than a half
century. He died September 26 at the age of eighty-
two years. The son of a physician, he also had five
brothers who were physicians and four sons who are
physicians.
Dr. Young was one among the pioneer psychiatrists
of the South. His opinion for many years that the
alcoholic and drug patient was a psychiatric and
medical problem has become today the accepted view.
He wrote many articles on psychiatric problems,
and especially those concerning the alcoholic, the
narcotic and maladjusted nervous individuals.
He moved to Covington from Abbeville, Louisiana,
where he founded the Fenwick Sanitarium, in 1912.
Dr. Young was the first physician to report cases
of beri-beri in Louisiana. This report appeared in
the Journal of the American Medical Association of
January 10, 1903. Beri-beri today is recognized as
a vitamin deficiency.
He graduated from St. Charles College, Grand
Coteau, Louisiana, 1881, from the University of
Louisiana (now Tulane) in 1884, and interned at
Charity Hospital, New Orleans, La., for a year. He
did postgraduate work at Columbia University, New
York, New York Postgraduate, New York Polyclinic
and other eastern schools.
Dr. Young was a member of the St. Tammany
Parish Medical Society, Sixth District Medical soci-
ety and a fellow of the American Medical Association.
He was a member of the Louisiana Hospital Associ-
ation, The American Hospital Association and The
National Association of Private Psychiatric Hos-
pitals. He was an honorary member of the Alpha
Kappa Medical Fraternity, Alpha Theta Chapter at
Medical Department, University of Texas, Galves-
ton, Texas.
Dr. Young took an active interest in political and
local affairs and his charitable acts were numerous.
Surviving are one daughter, Mrs. Robert E. Put-
man, Shreveport, La., and five sons, Dr. John Dalton
Young, Shreveport, La., Dr. L. Roland Young,
Daytona Beach, Fla., Albert Laurie Young, Dr. Roy
Carl Young, Dr. Francis F. Young, Jr., all of Cov-
ington, La.; one brother. Dr. Lawrence R. Young,
Meadeville, Lg. ; and three sisters, Mrg. Eugenie Mc-
Henry, Zachary, La., Mrs. John J. Robira, Jennings,
La., and Mrs. E. A: Dieker, Cincinnati, Ohio:
POSTGRADUATE COURSE IN ALLERGY
The American College of Allergists offers an
intensive, practical course in allergy for 5J
days, November 5 to 10, inclusive, at Thorne
Hall, Northwestern University, Superior and
Lakeshore Drive, Chicago, Illinois. Men in the
service will be admitted free of charge, and for
others the registration fee is $100.
Inquiries should be addressed to the secre-
tary of the American College of Allergists, 401
La Salle Medical Building, Minneapolis 2, Min-
nesota.
DR. WALTER BRUCE MAXWELL
Dr. Walter Bruce Maxwell, 93, died September
21 at his home in Nesbitt, where he was born August
2, 1852. He graduated from Louisville Medical College
and returned to Nesbitt to take up his father’s pro-
fession and practiced there until 1920.
He was appointed postmaster of Nesbitt by Grover
Cleveland, and resigned forty years later with a
perfect record. He also operated a drug store for
years after he abandoned his medical practice.
He was a member of the Nesbitt Presbyterian
Church.
Surviving are four sons, Raymond Maxwell, Da-
vid W. Maxwell of Memphis, and Norman B. and
Walter Bruce Maxwell, Jr., of Nesbitt, and two
daughters. Miss Mary Maxwell of Nesbitt, and Anne
Byrd of Whitehaven.
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — V7. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
PEDIATRICS
The Importance of Detecting Tubercu-
losis in Children. The Journal A.M.A., July
21, 1945. J. A. Myers, M.D. F. E. Herrington,
M. D., Minneapolis and E. Garcia Saurez, M. D.
Santiago, Chile.
The authors have this to say concerning
Detection of Tuberculosis in Children:
“Children infected with tubercle bacilli un-
der the age of twelve years occasionally de-
velop the acute reinfection type of tuberculosis,
such as miliary disease, pneumonia, meningitis,
pericarditis, pleuritis, peritonitis and synovitis.
During this age period the chronic reinfection
type of disease occasionally develops in the ex-
trathoracic organs such as the bones and
joints, but the lungs are involved with great
rarity. The reinfection type of chronic pul-
monary tuberculosis begins to make its appear-
ance among tuberculin reactors in the early
teen ages and increases in frequency with the
decades. Since this fact was established the
previous enthusiasm for examination of school
children has waned; indeed, in some places
such work has been abandoned. This is an
extremely unfortunate situation and is without
practical or scientific foundation.
Every child who reacts to tuberculin has pri-
mary tuberculosis (tuberculosis infection).
This disease begins with the first focalization
of tubercle bacilli by neutrophils. From this
stage it is a matter of reinfections and the
like which determine whether the disease will
incapacitate or kill. Illness and death from
tuberculosis always begin with the simple and
apparently harmless infection, just as ‘a
459
journey of a thousand miles begins with a
single step.” To refuse or neglect to find the
infected child and conduct the necessary pro-
cedure in his behalf in any community is to
ignore or overlook an important phase of tu-
berculosis work.
The finding of primary tuberculosis (tuber-
culous infection) in a child invariably estab-
lishes two important facts: 1. Usually a con-
tagious case has been in the child’s environ-
ment. (Obviously the infected person should
be sought, if still alive, and be prevented from
spreading tubercle bacilli).
2. The child has at least lesions of primary
tuberculosis containing living tubercle bacilli.
Moreover, his tissues have become so sensi-
tized to tuberculo-protein that this substance
is now a deadly poison to them. The sensitivity
makes reinfections from exogenous or endo-
genous sources far more dangerous to him
than was the first infection; therefore physi-
cians, public health workers and parents must
be constantly on guard for the destructive
type of lesions in any one of many parts of
the body.
The toll of primary tuberculosis is far
greater than is generally realized. Bogen made
a painstaking analysis and concluded that ap-
proximately 50 per cent of infected persons
at some time have clinical lesions. Not all who
develop such lesions die from them — many
are not even incapacitated. Nevertheless, the
toll in morbidity and mortality is significant.”
“‘In most parts of the world at present
the children constitute the only group over
which one can exercise complete tuberculosis
control. The child is born free from tubercle
bacilli, and if his environment is adequately
guarded his body will remain uncontaminated
with these organisms. This necessitates com-
plete examination of all who are to be his adult
associates to find (1) those who already have
clinical tuberculosis and (2) those who react Lo
tuberculin and are potential cases of such dis-
ease. Those who on first or subsequent ex-
amination are found to have clinical tubercu-
losis must be kept from the child’s environ-
ment unless it can be proved continuously
that their disease is not contagious. The child
himself should be tested periodically to make
sure that no unsuspected contagious case
among transients and the like has come into
his environment and infected him. This pro-
460
State Board of Health
October, 1945
cedure should not be limited to childhood but
should be continued when adulthood is at-
tained. This is not a theoretical consideration
of idealists. It is actually in practice with a
high degree of success and must be the ulti-
mate goal in every home and community.”
COMMENT
This is a most valuable article and should
be read by every practitioner in Mississippi.
I seriously doubt if we are doing a sufficient
amount of tubercular testing on children be-
cause when we get a positive tuberculin in chil-
dren we know that child has been definitely ex-
posed to an open case of tuberculosis, hence,
the importance of finding the carrier or con-
tact and eliminating the exposure since it is
dangerous to not only this child but to other
children with whom he may come in con-
tact.' ; ■
In our experience the patch-tuberculin test
has served just about as well as the intra-
dermal test, in fact, it is our practice to do 3
the patch test first and if it shows positive
we then do the intradermal test and if both
are positive we then resort to x-rays of the
chest.
These authors bring out the point of the
uselessness of x-rays in making a diagnosis
of tuberculosis in children to which we hearti-
ly agree and yet we feel that these positive
reactors should be x-rayed just the same as
if one were taking the temperature to see if
they had fever. Occasionally one will see some
pathology by x-ray that would not be detected
otherwise. All in all this is a splendid article
and we would commend it be read by the
medical profession of this state.
State Board of Health
Felix J- Underwood, M .D.
HEALTH AND THE VICTORY
Good health unquestionably iplayed a
tremendous role in the victory the allies
have just achieved over the most ruth-
less aggressors of all time. The relative free-
dom from epidemic disease which has hamper-
ed the course of previous wars and the extreme
care given to protecting health contributed
immeasurably to the all-time record of Ameri-
can production and to the efficiency of our
fighting men.
Peace has come at last, but if it is to last
we must devote to it the same intensity of ef-
fort and purpose given in bringing the enemy
to its knees. The brave spirit of those who
bore the brunt of the long, bitter struggle to
bring order out of chaos and light again to
the world can never be forgotten, and our
gratitude can be but a humble outpouring
as we reflect upon how much it has cost to
give civilization another chance. The courage,
unselfishness, resourcefulness and ingenuity
of those who made victory possible should
inspire constructive activity more than ever be-
fore to make a better way of life for mankind.
A new era has come and because of the re-
cent developments in destructive science the
basic truth that the most important thing in
all the world is knowledge of how to live.
Nothing must be left undone to put to work
for mankind’s good the scientific discoveries
of the past few years. Given the same skill,
organizing ability and spirit of unselfishness
which went into our war efforts, great things
can be achieved.
In gaining knowledge of how to live, health
comes to the forefront. Invention and dis-
covery would be of little value if man did
not have the ability to use and enjoy the
fruits of his labor. Good health is therefore
of first importance. The most remarkable
scientific discovery will never overshadow
this fact. Victory over diseases is the goal
toward which we now strive — it is possible
to achieve it if given proper support.
Many public health activities were necessar-
ily curtailed during the war. Swatting every
other fly and killing every other mosquito
does not make for the most effective program,
but when funds and personnel are limited there
seems little effective program, but when
but when funds and personnel are limited there
seems little alternative. There is much unfinish-
ed work in public health and it is earnestly hop-
ed that adequate attention can be given many
October, 1945
461
State Board of Health
of its neglected phases at the earliest possible
moment. Tuberculosis, hookworm disease, ty-
phus fever and certain other preventable dis-
eases are far too prevalent and can and must
be brought under control. Undulant fever can
be checked by the pasteurization and safe-
guarding of milk supplies. Full time local
health service for every area of the state
is one of the first essentials in insuring ade-
quate health protection to all citizens. This
has long been one of the major goals of the
State Board of Health and one which it is
hoped can soon be achieved. Health accomplish-
ments as related to expenditure of funds have
been good in the past, but as we face the
future it is all too obvious that there are
many needs which must be met and problems
which must be solved. Public health workers
pledge their best efforts in helping man at-
tain that most important of the four free-
doms — freedom from disease. With the con-
tinued cooperation of the medical and allied
professions and adequate legislative and other
support, there is every hope that a new peak
in health security will be reached in the not
far distant future.
*45-***
School Nursing Service
The school nursing service is not a specializ-
ed service, points out Miiss Lucy E. Massey,
school health nurse, but is one of the regular
functions of all public health nurses. It does
have its special problems however and calls for
close collaboration with teachers and others
attached to the educational system. The team
formed by the nurse and the teacher wields a
broad influence in the guidance and develop-
ment of children, enabling them to learn early
the essentials of wholesome living. Among the
duties of the school health nurse are the fol-
lowing :
1. Plan regular visits to the schools of her
district.
2. Advise with teachers and school admin-
istrators in regard to the development of
effective school health programs.
3. Instruct teachers in groups and indivi-
dually concerning health services which
they may perform ; for example, vision
testing, weighing, hearing testing, etc.
4. Assist teachers in control of communi-
cable diseases through instructing them
in recognition of symptoms and preven-
tive measures.
5. Act as consultant with the teacher in re-
gard to health problems of the individual
children.
6. Interpret the child’s health needs to par-
ents, teachers, and to the children them-
selves.
7. Make home visits to inform parents of
the child’s needs and also to learn some-
thing of the child’s background.
8. Discover and promote community ser-
vices and agencies which can be used to
aid both teachers and parents in giving
better health care to children.
To serve most efficiently, the school health
nurse must necessarily have an understanding
of the technics and methods of modern edu-
cation. She needs to know enough about the
problems of the school to make her own con-
tribution realistic and practical. Both nurse
and teacher must realize the need for careful
integration of their services to the child in
order to attain the most effective results.
The School Health Service inaugurated in
July, 1942 under the joint administration of
the State Board of Health and the State De-
partment of Education has been able to re-
cord good progress. In addition to the School
Nursing Service its program is concerned with
(1) the training of teachers to qualify them
to supervise a classroom group of children in
good health practices; (2) school nutrition and
school lunchrooms; (3) medical correction of
the children’s defects; and (4) a statewide
program of physical education to permit the
development of a higher level of physical fit-
ness. The Health Education Division of the
State Board of Health engages in a well-
rounded program of community health educa-
tion which contributes greatly to the total
effectiveness of the School Health work.
*****
Cancer Control
A hopeful note in curbing cancer in Mis-
sissippi comes with the announcement that
the American Cancer Society is establishing
state offices in the Lorenz Building, 514 \
Amite Street, in Jackson. Bringing its program
of “Fight Cancer with Knowledge” closer
home to Mississippians, greater effort will be
directed toward educating people regarding
the early symptoms of cancer and the im-
portance of early diagnosis and immediate
treatment. Provisions will be made for as-
sisting cases unable to secure treatment other-
wise. Physicians of Mississippi are already
coloperating to insure the success of this
462
October, 1945
State Board of Health
important work. The American Cancer So-
ciety, since its organization in 1913, has al-
ways been interested in and has stressed the
educational phase of the program. Its success,
however, depends upon the availability of diag-
nostic and treatment facilities and a medical
prefession skilled in their use and prepared
to make the benefits available to cancer pa-
tients. Provision must therefore be made for
the care of people who have been reached by
educational efforts. Serving as regional medi-
cal director of the American Cancer Society
is Dr. Alton Oschner. Dr. Felix J. Underwood
is chairman of the State Executive Committee
and Mrs. Elizabeth N. Wates is state com-
mander. It is planned to organize local units
in each of the eighty-two counties at the
earliest possible date in order that the educa-
tional programs may be carried out most ef-
fectively.
*****
Use of DDT
It has been reported that the discovery of
the value of DDT in the control of certain
insects, especially those capable of transmit-
ting disease, has been the greatest single
advance in preventive medicine to be develop-
ed during the war. Certainly this insecticide
has been of immeasurable value in the protec-
tion of our troops against insect-borne dis-
eases.
The information that has reached the pub-
lic generally concerning the DDT has fired
the imagination of thousands of our citizens
to the extent that it appears many are labor-
ing under a mass of misinformation, and are
looking to DDT to relieve them forever from
the trials and tribulations of household pests.
It appears that many people believe once they
can secure a quantity of the material they
will be freed from the annoyance of mosqui-
toes, flies, cockroaches, bed-bugs, moths and
other common household pests. DDT has
wonderful properties in destroying insect life
of the household variety when used in proper
amounts, in the proper way, and with proper
equipment. It definitely has limitations and
its use without proper knowledge of these
limitations will not produce the results the
public is expecting.
The receptiveness of the public to its use
and the desire to secure the material is also
likely to produce some disappointment as pro-
ducts are likely to appear on the market which,
though they may contain some DDT, will not
do what the individual expects of them. To
this end one should purchase DDT insecticide
only from reliable concerns in whom one has
confidence.
For household purposes DDT preparations
are likely to appear in several forms. One
form is likely to be a two and one-half to
a five per cent aqueous emulsion for use as
a residual spray. This material when sprayed
on the interior walls and ceilings of houses
in proper amount' and with proper equip-
ment will be quite effective in destroying
household insects that rest on the walls for
a sufficient length of time. The material so
applied will have a residual effect which will
last for several months. To be effective a-
gainst cockroaches, this emulsion should be
forced into all cracks and crevices, and should
be carefully applied in pantries, around cup-
boards, sinks, the undersides of tables and
other darkened shelter where roaches hide
during the day.
A five per cent solution in kerosene will
likely also be available. In this form it should
be particularly effective when properly ap-
plied around stables, dairy barns, on screens
or other surfaces unaffected by kerosene.
The material is likely to appear on the
market in the form of a ten per cent dust.
This is effective in the control of fleas on
dogs but should not be used on cats. DDT
has toxic properties and cats dusted with the
material could lick sufficient of the DDT off
their bodies to get a toxic dose. The dust when
properly used and especially when dusted in-
to cracks and crevices with a dust gun has
value in the control of cockroaches.
DDT when mixed with standard insecticides
appears to improve the killing powers of such
insecticides. It is, therefore, likely that in-
secticides will appear on the market reinforc-
ed with DDT. These should be of value in
fine sprays which give a quick “knockdown’*
of insects as the DDT will increase the per-
centage or kill over that of the same in-
secticide without DDT. Such insecticides will
probably have little if any residual value since
the percentage of DDT will be too low and
little if any coating of wall surfaces with
DDT will result from their use as “knock-
down” insecticides.
DDT preparations are of value in controlling
insects around farm animals. Information for
such uses, however, should be obtained from
the State Plant Board of Extension Depart-
ment at Mississippi State College.
Experience has indicated that for use a-
October, 1945
Woman’s Auxiliary
463
round the home the materials must be proper-
ly applied in proper strength to get satis-
factory results. This implies that proper equip-
ment is needed. Until such equipment is avail-
able there is likely to be much disappointment
in the results obtained. Since the amount of
DDT contained in a preparation will determine
to a great extent its efficiency for the pur-
pose intended one should know the percent-
age of DDT in a preparation before buying it.
Since DDT is toxic to man and animals,
it must be used with some caution around
the house. It should not be allowed to come
in contact with food or food utensils. It should
not be used in oil solutions or emulsions unless
the hands and other parts of the body it
might come in contact with are protected since
the skin absorbs DDT in oil mixtures. Too
much absorption may lead to the development
of a serious rash on the exposed skin and a
severe nervous condition may develop.
PREVALENCE OF COMMUNICABLE
DISEASES IN MISSISSIPPI
Aug.
Aug.
Aug.
5-Yr.
1945
1944
Avg.
Acute Poliomyelitis
14
32
20.0
Bacillary Dysentery
1197
1568
1341.6
Dengue
0
0
0.0
Diphtheria
69
40
41.2
Influenza
1506
1080
1203.0
Measles
175
189
220.6
Meningococcus Meningitis
6
9
5.8
Other Forms Meningitis
4
.3
2.6
Pellagra
217
257
280.0
Pneumonia
600
456
435.2
Pulmonary Tuberculosis
132
122
131.6
Scarlet Fever
33
30
28.8
Smallpox
0
0
0.0
Tularemia
5
4
3.8
Typhoid Fever
14
27
35.0
Typhus Fever
46
27
22.4
Undulant Fever
13
7
6.8
Whooping Caugh
471
968
744.8
July
July
July
5-Yr.
1944
1944
Av’ge
Acute Poliomyelitis
2
23
14.8
Bacillary Dysentery
1728
2285
2177.4
Dengue
0
0
.2
Diphtheria
28
25
21.6
Influenza
909
1042
994.0
Measles
306
396
375.6
Meningococcus Meningitis
6
7
6.4
Other Forms Meningitis
6
3
1.8
Pellagra
218
230
308.2
Pneumonia
438
509
400.8
Pulmonary Tuberculosis
143
160
135.4
Scarlet Fever
24
10
15.4
Smallpox
1
0
.4
Tularemia
2
2
1.8
Typhoid Fever
15
19
30.0
Typhus Fever
25
22
13.6
Undulant Fever
15
5
4.4
Whooping Cough
644
1239
941.0
Womans Auxiliary
President
Vicksburg
. . Mrs. L. J. Clark
President-Elect
Corin', h
. . Mrs. Stanley Hill
Cirst Vice-President
Jackson
...Mrs. H. C. Ricks
Second Vice-President
Sanatorium
Mrs. Henry Boswell
Third Vice-President
Mrs. W. H. Anderson
Buoneville
Recording Secretary
Jackson
Mrs. Geo. W. Owens
Fourth Vice- President
Jackson .
. .. Mrs. Pen Walker
Treasurer
Cleveland
Mrs. J. D. Simmons
Historian
Mrs. Harvey C, nr risen
Jackson
FROM OUR PRESIDENT
Dear Auxiliary Member:
The new year has started and by this time
the auxiliaries have held one or more meetings.
I trust that you have started the year with
renewed interest and enthusiasm and an honest
endeavor to increase the usefulness of the or-
ganization we are privileged to be members of.
Now is the time to get subscriptions to
Hygeia. Our state is lagging in the circulation
of this excellent magazine. Unless we as
doctors’ wives promote the sale of this
health magazine we cannot expect other groups
to do so. Many cash prizes are offered to
auxiliaries with the greatest increase in sales
of Hygeia. Let’s get busy and try for some
of these prizes. The contest closes January
first.
The fall executive board meeting of the
Auxiliary was held in my home in Vicksburg
and I was most appreciative of the good at-
tendance. It was a privilege and great plea-
sure to be hostess to this enthusiastic and
interesting group of leaders in the state. I
am not unmindful of the difficulty yet ex-
perienced in travel and I am deeply grateful
for the presence of each board member.
The four-year medical school and the
proposed law on pre-marital examinations
were endorsed by the executive committee.
We shall endeavor to give these measures our
best efforts.
My objective in membership is “every
doctor’s wife an Auxiliary member.’’ Please
make an honest effort to set every doctor’s
464
Woman’s Auxiliary
October, lJHo
wife in our state into her local organization.
It is preferably to affiliate with an organized
auxiliary but if that is not possible, become a
member-at-large.
With every good wish for your continued
effort and interest and with the earnest de-
sire for the broadening of your service to
the community and state, I am
Cordially,
Anne J. Clark, President.
NEW AUXILIARY ORGANIZED
Doctors’ wives in the second district came
together during a meeting of the North Mis-
sissippi Medical Society on October 23 and
were organized into a new auxiliary. The state
president, Mrs. L. J. Clark of Vicksburg, and
Mrs. Stanley Hill, president-elect and organiza-
tion chairman, assisted.
Officers elected are: president, Mrs. V. B.
Harrison of Oxford; vice-president, Mrs. D. W.
Whitaker of Sardis; secretary-treasurer, Mrs.
A. IH. Little of Oxford; and Hygeia chairman,
Mrs. J. R. Sims of Oxford. Others present
who became charter members included, Mrs.
J. S. Donaldson of Oakland, Mrs. E. R. Shirley
of Money, Mrs. G. H. Wood of Batesville, Mrs.
Lee Rogers, Jr., and Mrs. John Culley of Ox-
ford. Mrs. L. L. McDougal of Booneville and
Mrs. J. K. Avent of Grenada were visitors.
After explaining the purpose of the organi-
zation, Mrs. Clark was followed by Mrs. Stan-
ley Hill, who emphasized the helpfulness of
both the Bulletin and the yearbook, and
pointed out ways doctors’ wives can aid their
husbands through membership in the Auxiliary.
Mrs. J. K. Avent, legislative chairman, report-
ed on the advantages of a pre-marital law,
the importance of opposing the Wagner-Mur-
ray-Dingell bill, and encouraged support of the
proposed four-year medical school for Missis-
sippi.
Dinner was arranged in the university cafe-
teria for the doctors and wives who attended.
ISSAQUENA — SHARKEY — WARREN
The Issaquean-Sharkey-Warren County
Auxiliary held its first meeting for the season
October 24 in the home of Mrs. Hugh Johnston.
The new president, Mrs. Edley Jones, presid-
ed graciously and welcomed the out-of-town
guests, who were Mrs. Edward King and Mrs.
Ralph Platou from New Orleans, Mrs. Toxey
Hall from Belzoni, Dr. Virginia Howard and
Dr. Estelle Magiera from Jackson.
Dr. Virginia Howard, who is with the State
Board of Health, was the guest speaker and
gave a most instructive talk on maternal and
child care. She stated that ten years ago the
problem was infection, today it is nutrition,
and in the future it probably will be mental
health. She gave very interesting statistics.
After the meeting adjourned, tea was served
in the dining room. The table was beautifully
appointed with a handsome lace cloth and
a silver bowl of pink roses. The hostesses
were Mrs. Hugh Johnston, Mrs. Sidney John-
ston, Mrs. Lawrence Clark, Mrs. George Martin,
president — Mrs. Edley Jones, president-elect —
Mrs. Augustus Street, first vice-president —
Mrs. James O’Dell, secretary — Mrs. Willard
H. Parsons, treasurer — Mrs. Martin Lewis,
parliamentarian — Mrs. Sidney Johnston, his-
torian— Mrs. W. C. Poole.
NORTHEAST MISSISSIPPI THIRTEEN
COUNTIES AUXILIARY
The members of the Northeast Mississippi
Thirteen Counties Auxiliary met in September
at the home of Mrs. W. N. Reed of Amory,
the doctors’ wives of Amory sharing in ex-
tending the hospitality. Georgeous gladioli
and asters were used throughout the house in
artistic arrangements, adding charmingly to
the decor of the setting.
Following a deliciously planned luncheon,
served buffet style, Miss Derrecott of Amory
played a number of piano selections, after
which the group went into a business session.
Mrs. Stanley Hill of Corinth presided, in the
absence of the president.
CENTRAL MEDICAL AUXILIARY
The Woman’s Auxiliary to the Central Medi-
cal Society held its first fall meeting on Tues-
day in the lovely home of Mrs. R. C. O’Ferrall
on St. Ann Street.
The meeting was called to order by Mrs.
George Riley, the president, and prayer was
offered by Mrs. Robert B. Price.
A short talk was made by the president and
some plans for the coming year were dis-
cussed.
The members were delighted to have as
their special guest, the state auxiliary presi-
dent, Mrs. Lawrence Clark of Vicksburg, who
October, 1945
Editorials
465
was introduced by Mrs. Riley. Mrs. Clark
brought an inspiring message, stressing mem-
bership, Doctors’ Day and Hygeia.
After the business session, members and
guests were invited into the dining room,
where delicious ices, sandwiches and cakes
were served from a beautifully appointed
table.
Hostesses were: Mrs. R. C. O’Ferrall, Mrs.
Tom Blake, Mrs. A. L. Gray, Mrs. W. L.
Hughes, Mrs. Robert Price, Mrs. J. A. Milne,
Mrs. George Riley, Mrs. J. O. Segura.
Those present were: Mrs. Byron Alexander,
Mrs. J. F. Armstrong, Mrs. W. R. Bethea, Mrs.
J. G. Blaine, Mrs. Tom Blake, Mrs. John Carr,
Mrs. Lawrence Clark, Mrs. B. C. Campbelle,
Mrs. J. Gordon Dees, Mrs. C. H. Denser, Mrs.
F. A. Donaldson, Mrs. Boyd Edwards, Mrs..
Harvey Garrison, Mrs. A. L. Gray, Mrs. P. R.
Graves, Mrs. W. F. Hand, Mrs. Robin Harris,
Mrs. T. B. Holloman, Mrs. N. C. House, Mrs.
I. C. Huggins, Mrs. W. L. Hughes, Mrs. G. M.
Knowles, Mrs. Lawrence Long, Mrs. J. B. Mar-
shall, Mrs. A. J. Mcllwain, Mrs. J. A. Milne,
Mrs. I. J. Newton, Mrs. R. C. O’Ferrall, Mrs.
George Owen, Mrs. Robert B. Price, Mrs. Guy
Post, Mrs. A. E. Pullon, Mrs. Lee Reid, Mrs.
George E. Riley, Mrs. H. C. Ricks, Mrs. J. O.
Segura, Mrs. W. A. Smithson, Mrs. W. C.
Thompson, Mrs. I. B. Trapp, Mrs. N. B.
Walker, Mrs. J. P. Wall, Mrs. A. G. Wilde,
Mrs. T. E. Wilson, Mrs. N. C. Womack, and
Mrs. Yates.
(continued from page 457)
AMERICAN COLLEGE OF CHEST
PHYSICIANS
The meeting of the American College of
Chest Physicians, to be held conjointly with
the Southern Medical Association, is scheduled
for November 11 through November 12, 1945,
in Cincinnati, Ohio.
Believe it or not, Dr. L. L. McDougal, Sr.,
of Booneville, reports that the father of the
first baby he ever delivered, July 3, 1905, is
the father of the last delivered, August 13,
1945, forty years and forty days difference
in the ages of the two babies, half-sisters.
Can you match Dr. McDougal with one as
good?
Arkansas has one physician to 1079 popula-
tion, Louisiana, one to 900 people, Tennessee
one to 984, while Mississippi has only one to
2200 population. Arkansas has one medical
school, Tennessee has three, and Louisiana has
two. And yet we hear some saying that hav-
ing a medical school makes no difference about
the number of doctors we have. Doctors above
all people should keep their minds open to the
truth and think straight.
We are now extending a cordial invitation
to all doctors in the state who have been
practicing fifty years to be our guests at a
luncheon at the Mississippi State Medical Asso-
ciation at its annual sessian next May in
Jackson. ;
According to a recent hospital survey, Hinds
County has one doctor to every 1262 people
while Claiborne has one to 6,405, which, of
course, indicates the need of a better distribu-
tion of doctors.
On the per capita distribution of funds sys-
tem, the hospitals did receive two and one-half
dollars per day for a room, a ward bed. If this
were increased to four and a-half per day per
bed, it could serve a double purpose. The larger
and better equipped hospitals in the larger
towns would be more willing to take the chari-
ty patients into their institutions, while this
boost of price would be a real help to the small
hospital struggling for existence, would enable
it to have better equipment and to give better
service.
To the best of our information Mississippi
has 112 hospitals in the state as follows:
twelve with less that 111 beds, forty-one be-
tween eleven and twenty-six; twenty-three be-
tween twenty-six and forty-nine; twenty-nine
between sixty and ninety-nine beds, and seven
with a hundred beds and over. Yet our state
seems to have the lowest number of beds per
thousand population of any state in the union,
about 1.6 and in beds occupied just a few
years ago it was at the foot of the list. Our
hospitals, however, are quite well distributed.
It would seem that in number we have really
more hospitals than needed. Private individuals
have done some fine missionary work in furn-
ishing hospitals for public service, but the
time is now at hand to consolidate some places
into health centers and have more non-profit
open hospitals made stronger and better e-
quipped than the ones we have. Let us think
along this line sincerely and unselfishly.
(small volume dose), Y causes patient no appre-
cutaneously, or Ramose Yj , offers the solution to
ciable discomfort. R'-t,|ex treg
such conditions as.
. UAmiling of Pregnancy
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m;xed vitamin B factors.
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Uterosalpingography*
An Analysis of Twenty-five Unselected Cases.
P. E. SMITH, A. B., M. D., F. A. C. S.
Hattiesburg, Miss.
s the name implies, uterosalpingography
^is x-ray photography of the uterine and
tubal cavities following injection of a
radiopaque fluid.
In 1914, two' French doctors, Dartigues1 and
Dimied, worked out this method, but due to
the war their results were not published until
1916. In the meantime, W. H. Cary published
a “Note on Determination of Patency of Fallo-
pian Tubes by Use of Cdllargol and X-ray
Shadows”, and claimed the honor of being
first to use this method. In 1915, I. C. Rubin
published his results with; .tH^ use of collar-
gol. Its use was abandoned because of its
lack of opacity and severe peritoneal reac-
tions incited by it.
In 1921, Sicard and Forrestier used lipiodol,
which was developed in 1902 by Lafay, in
successfully demonstrating body cavities. Its
advantage over media used previously is its
non-irritating character, slow absorption, its
viscosity and high opacity — 40 per cent
iodine — its seri-disinfecting— and mild ger-
micidal properties^ They did not mention lipio-
dol in uterosalpingography. In 1921, Heuser
of Buenos Aires first- described the use of
lipiodol in this connection and he made the
first uterosalpingograms^ with lipiodol. Carelli
of Buenos Aires also published beautiful pic-
tures of the injected uterus and .tubes inde-
pendently. The method thereafter spread uni-
versally and many have publishedthe results
of their experiences with hundreds of cases
bringing about improvement in technique and
in the interpretation of the films.
In 1923, Kennedy reported use of a 20- per-
cent solution of sodium bromide and demon- -
strated tubal occlusion in eighteen cases. La-
querriere and others used sodium bromide and-
sodium iodine.
Williams and Reynolds, in 1925, made
uterosalpingograms by injecting an emulsion
of barium sulphate and bismuth. None of these
methods were entirely satisfactory.
In 1937, Titus, Tafel, McClellan and Messer2
called attention to troublesome reactions, such
•Read before the Hattiesburg Clinical Society
on September 16, 1945.
467
as “chemical” salpingitis, which occasionally
follow use of lipiodol and advocated use of
aqueous 40 per cent skiodan in 20 per cent
acacia (Winthrop) as being suitable for vis-
ualization with the minimum of local irritant
reaction.
In 1939, Heilman, Jonas and Rosen^ present-
ed a series of twenty-four cases in which
skiodan-acacia solution was used and satis-
factory roentgenograms were obtained with no
untoward reactions.
In 1939, Rubin4 published “The Compara-
tive Value of Radiopaque Substances Used in
Uterosalpingography”. His experiments were
performed on the rhesus monkey, because this
animal resembles most the human being. The
solutions used were diodrast, hippuran, skiodan
with acacia, umbrathor, lipiodol and iodochlor-
ol. He concluded that iodochlorol yielded satis-
factory roentgenograms. Umbrathor gives
good shadows, but its persistence is disadvan-
tageous. The crystalline iodine compounds,
even skiodan with acacia, passed into the peri-
toneal cavity so rapidly, that the tubal out-
lines were overshadowed.
In 1944, Hudgins5 demonstrated his uterine
canula which is cone-shaped, and screw type,
with a ball valve to prevent escape of fluid,
and is adaptable to a Luer syringe. It re-
mains in place until after the films are made,
and is then removed. It facilitates the injection,
and allows the patient to walk to the x-ray
room after the injection has been made on
the examining table.
The normal findings show the uterus, to
be triangular in shape and smooth in outline.
The fallopian tubes are small dense penciled
lines, which increase in diameter gradually
from about the middle to the fimbriated ends.
Their course is usually lateral from the cor-
hua, and it is undulating. There is a sphinc-
ter at the cornual end, a spasm of which
sometimes leads to failure of filling of the
tube, and the erroneous diagnosis of tubal
occlusion. This error can be overcome by
prolonging the period of injection. Oil which
has escaped from the fimbriated end of the
tube casts large irregular shadows and ap-
468
Uterosalpingography — Smith
November, 1945-
pears as droplets at times. The presence of
excessive amounts of oil may overshadow im-
portant structure's and should be avoided.
Indications: Conditions in which uterosal-
pingograms may give diagnostic information
are: (a) Anomalies of the uterus, such as in-
fantile uterus and bicornate uterus, and the
degree of deformity. Malpositions are readily
diagnosed bimanually and uterosalpingography
is not needed nor desirable, (b) Sterility.
Uterosalpingography often is able to offer
very definite information after the gynecolo-
gist has exhausted all of his other diagnostic
procedures. Schmitz states that the Rubin
test is used in sterility to determine the paten-
cy of the tubes and that salpingography is
used to locate the site of the obstruction.
Pfaler6 and Vastine state that it has a bor-
der field and also it not infrequently shows
the tubes to be open when the Rubin test
indicates that they were closed. Uterosalpin-
gography is of value in checking the results
of operations for sterility as salpingostomy
and tubo-uterine implantation, (c) Pathology
of the tubes- — Occlusion of the fallopian tubes
by an inflammatory process occurs most
frequently at the fimbriated ends. In this
event, a clubbed appearance of the lateral ends
occurs which varies in size. If the uterine
end is blocked, all that can be reported is an
occlusion of the uterine end of the tube. If
the block is only partial and a few drops en-
ter the dilated tube, they form globules close
together presenting the typical mulberry ap-
pearance of hydro- or pyosalpinx. Numerous
instances are on record of clinical relief fol-
lowing injection of lipiodol for diagnosis in
cases of chronic inflammations of the uterus
or tubes, *due to its germicidal value. Also
cases have been reported of women later be-
coming pregnant after this procedure. This
may possibly be explained by the presence of
a slight %dhesion of the fimbriated end of the
tube as a result of a low grade inflammatory
process which has been opened by the pressure
of the injection, and remained open due to the
oily and germicidal properties of the lipiodol.
-(d) Ovarian or parametrial tumors — These
usually produce -an elongation and narrowing
of the fallopian tube with the smooth curve
conforming to the shape of the tumor. The
uterus and the tube are displaced, (e) Uterine
tumors. Subserous fibroids may produce no
change^ in the cavity of the uterus. .Submucous
fibroids and polyps produce a defect in the out-
line of the uterine cavity.
Contraindications are cases of recent hemor-
rhage, inflammatory conditions that are not
completely quiescent, active infections, malig-
nancies, especially those involving the cervix,
uterine gestation, fever and menstruation. The
time to perform uterosalpingography is about
a week after cessation of menstruation.
A few dangers may be mentioned such as
exacerbation of an old infection, “chemical”
salpingitis, ruptured tube, abortion, accidental
Figure No. 1. Case No . 10 shows a normal uterosal-
pingogram.
Figure 2. a. Case No. 11 shows uterus to be normal
and both tubes closed at the fimbriated ends. This
film was taken immediately after injection of the=
iodochlorol.
November, 1945
Uterosalpingography/ — Smith
469
injection of iodized oil into the veins of the
uterus from too much pressure. This is of no
consequence, as shown by Cicard and Forres-
lier, by injecting the oil directly into the blood
stream of animals and human beings. Cran-
dell and Walsh have shown that the iodized
oils are non-irritating to the peritoneum.
These dangers can be obviated by careful
selection of cases and gentle technique.
Figure 2. b. Case No. 11. Film taken 3 days af-
ter injection of iodochlorol shows oil in the peri-
toneal cavity.
Figure No. 3. Case No. 13 shows uterine cavity
to be normal and bilateral tubal obstruction at the
cornua, his was probably due to an error in techni-
que as the patient became pregnant about one year
later. No delayed films were taken.
Iodochlorol was used in the twenty-five
cases here reported, and the technique was
carried out on ambulatory patients in the
supine position on a roentgen table. No
anesthesia or sedation was used. Instruments
used: vaginal speculum, open on one side,
cervical tenaculum, uterine sound, uterine can-
ula that has a cone-shaped rubber guard to
prevent escape of the fluid from the cervix,
and a pressometer (Becton-Dickerson and
Co.) attached to the canula to inject the
fluid under manometric pressure. A mercury
pressure of about 170 mm. was used. The cer-
vix and vagina were painted with tincture
merthiolate, and under aseptic precautions, a-
bout 5 or 6 cc. of iodochlorol injected. The
fluoroscope was used to determine when the
uterus and tubes were full, and then the
x-ray exposure A. P. was made, after which
the fluid was allowed to escape from the uter-
us. Additional films, several days later, fre-
quently showed the oil to have escaped
through the fimbriated end of the tube into
the peritoneal cavity, while the previous films
taken immediately after the injection showed
the oil still retained in the tube. The use of
the Bucky diaphragm will give clearer pic-
tures.
Figure No. 4. Case No. 9 shows the uterine cavity
to be normal but pushed to the right by a large
palpable cyst in the left tubo-ovarian region; left,
tube obstructed at the cornu and right tube obstruct-
ed at the fimbriated end.
470
U terosalpingogr aphy? — Smith
November, 1945
Figure No. 5. Case No. 16, Uterus normal, right
tube closed at the fimbriated end and left tube
at the cornu. No delayed films taken. Rubin test
one week later showed one or both tubes to be open.
Figure No. 6. a. Case No. 18 shows normal uter-
ine cavity but deviated to the right; tubes closed
at the fimbriated ends.
Figure No. 6. b. Case No. 18. Film taken one
day after injection of oil showed no oil in the
peritoneal cavity.
Figure No. 6. c. Case No. Laparotomy was per-
formed one week after uterosalpingography. Pelvic
adhesions liberated, both tubes insufflated with air
from within and uterus suspended (Crossen method).
This is a check-up uterosalpingogram made one
year after the operation. Uterus normal and good
position but tubes closed at the fimbria. No delayed
films taken.
TABLE I. Report of Cases
NO.
AGE
Complaint or diagnosis
X-Ray Findings
Follow-up.
1
27
Sterility for 4 years.
Uterus normal; tubes
patent.
Became pregnant 3 years
later.
2
30
Sterility for 6 years.
Uterus normal; Left tube
patent, right tube closed
at the fimbria.
No pregnancies.
3
23
Sterility for 3 years.
Uterus normal; both
tubes closed at the fim-
bria.
No pregnancies.
November, 1945
Uterosalpingography — Smith
471
TABLE No. 1. Report of Cases , Continued.
NO
AGE
Complaint or Diagnosis
X-Ray Findings
Follow-up
4
27
Sterility.
Uterus normal ; both
tubes closed at the fim-
briae.
No pregnancies.
5
32
Sterility.
Uterus normal ; tubes
closed at the cornua.
No pregnancies.
6
Sterility for 7 years, fol-
lowing gonorrhea, child,
9 years old.
Uterus normal; rt. tube
closed at middle, It. tube
closed at fimbria.
No pregnancies.
7
35
Sterility for 10 years.
Has had Rubin test and
cervix amputated for
sterility.
Uterus normal; tubes clos-
ed at fimbriae.
No pregnancies.
8
27
Sterility for 2 years
Uterus normal; rt. tube
closed at cornu It. tube
closed at fimbria and di-
lated.
No pregnancies.
9
27
Sterility for 3 years
Large left cystic ovary
Uterus deviated to right;
It. tube closed at cornu, rt.
closed at fimbria.
No pregnancies.
10
30
Sterility for 4 years.
Husband has child, by
first wife.
Uterus normal ; tubes
patent
No pregnancies.
11
28
Sterility, 2 years.
Uterus normal; both tubes
appear closed at fimbriae.
Film taken 3 days later
shows oil in peritioneal
cavitv.
No pregnancies.
i
1
12
31
Sterility
Uterus normal; tubes clps-
ed at the fimbriae.
No pregnancies.
13
27
Sterility, 5 years
Uterus normal; both tubes
closed at the cornua. No
films taken later.
Became pregnant about 1
year later.
14
25
Sterility, 7 years.
Uterus deviated to right
and anteflexed; tubes
closed at cornua.
No pregnancies.
15
22
Sterility, 2 years.
Spermatozoa normal.
Uterus normal; tubes pat-
ent.
No pregnancies.
16
23
Sterility, 3 years.
Rubin test after revealed
one or both tubes to be
open.
Uterus normal ; rt. tube
closed at fimbria, It. tube
closed at cornu.
No pregnancies.
17
23
Sterility, 3 years.
Uterus normal; both tubes
appear closed at fimbriae.
24 hr. film shows oil in
peritoneal cavity.
Became pregnant soon af-
ter salpingogrophy men-
struated oil once after.
472
Uterosalpingography — Smith November, 1945
v. . . i i
TABLE No. 1. Report of Cases , Continued.
NO.
AGE
Camplaimit or diagnosis
X-Ray Findings
Follow-up.
18"
25
Sterility, 5 years.
Chronic pelvic inflamma-
tory disease (quiescent.)
Uterus normal; tubes ap-
pear closed at the fimbriae
24 hr. film shows no oil in
peritoneal cavity.
No pregnancies.
19
21
Sterility for 1 year.
Uterus appears rotated;
tubes obstructed at the
fimbriae. 24-hour film re-
veals no oil in peritoneal
cavity.
No pregnancies.
20
20
(Sterility for 2 years.
Uterus normal; right tube
closed at cornu; left tube
closed at the fimbria. 1
and 6 day film shows oil
in the peritoneal cavity.
No pregnancies.
21
40
Sterility, 5 years.
Uterus deviated to the
right and rotated; Both
tubes obstructed at the
cornua. Film 4 days later
showed no oil in the peri-
toneal cavity.
No pregnancies.
22
27
Sterility, 2 years.
Uterus nprmal; both tubes
obstructed at the cornua.
48-houf plate, no oil in the
peritoneal cavity.
No pregnancies.
23
37
Sterility, 12 years.
Artificial insemination
every month for 1 year,
previously. Spermatozoa,
normal.
Uterus normal; left tube
patent, right tube obstruc-
ted at the fimbria.
No pregnancies.
24
25
Sterility, 3 years.
Uterus normal; both tubes
appear closed at the fim-
briae, 48-hour film shows
oil in the peritoneal cavity
Film 2 weeks later showed
same amount oil in peri-
toneal cavity.
Became pregnant soon af-
ter.
25
28
Sterility, 5 years.
Uterus normal ; Right tube
patent, left closed at the
fimbria.
No pregnancies.
REFERENCES
1. Lajoie, Leon G. : Utero -salpingography . Cana-
dian Med. Assn. Journal, 44: 555 (June 1941.
2. McClellan, R. H., Titus, P., Tafel, R. E., and
Lory, E. C. : A New Non-Irritant Opaque Medium
for Uterosalpingography. Am. J. Obstetrics and
Gynecology. 37 : 495 (March) 1939.
3. Heilman, A. M., Jonas, J. Q. and Rosen, J.
A. : Uterosalpingography with Skiodan -Acacia. Ameri-
can Journal Obstetrics and Gynecology. 37: 107
(January) 1939.
4. Rubin, I. C. and Morse, A. H.: The Com-
parative Value of Radiopaque Substances in Utero-
salpingography. American Journal of Roentgenology.
41: 527 (April) 1939.
5. Hudgins, A. P.: Special Uterine Ganula for
Uterosalpingography Southern Medical Assn., Scien-
tific Exhibit. St. Louis, Mo. (November) 1944.
6. Pfahler, G. E. and Vastine, J. H.: X-rays in
Gynecology. The Cyclopedia of Medicine and Sur-
gery. F. Davis and Company. 13: 392. 1942.
Practical Points in the Differential Diagnosis and
Treatment of Appendicitis*
S. H. DAVIS, M. D.
Bruce,
The diagnosis of appendicitis is at times
one of the most difficult of all diagnoses
to make. Of course the typical acute case
is diagnosed without difficulty. Every physi-
cian is familiar with the diagnostic constella-
tion of generalized abdominal pain shifting to
the lower quadrant, with nausea, vomiting,
point tenderness, muscle rigidity, moderate
elevation of pulse rate and temperature, and
increased leukocyte count, chiefly in the poly-
morphonuclear neutrophiles. However, we often
forget that all of these things are present
in a few cases, a few of them are present in
the majority of cases, and virtually none of
them are present in quite an appreciable num-
ber of cases. It is the last series of cases that
tax our diagnostic acumen to the limit.
In a differential physical examination of the
suspected acute appendix, one should begin
with palpation of the lower left quadrant and
working around the abdomen counterclockwise
until the lower right quadrant is reached, using
first gentle and then deeper pressure. In a
typical case, the tenderness will increase as
one approaches McBurney’s point in the lower
right quadrant. Pressure over this area usual-
ly causes the patient to squirm and exclaim
with pain. In cases where there is an atypical
position of the appendix, the maximum point
of tenderness may be at the outer side of the
-right loin in the case of a retrocecal appendix,
or in the pelvis if it hangs over the pelvic
brim. In these cases rectal or vaginal examina-
tions are invaluable in revealing the 'tender
area, while in cases where the appendix points
medially and to the back of the abdomen and
lies under the mesentery of the ileum, deep
palpation is necessary to elicit the typical ten-
der area. Flexing the right thigh on the ab-
domen while extending the lower leg, is a
valuable maneuver where a deep seated ap-
pendix may be lying near the psoas muscle.
Rebound tenderness and hyperesthesia of the
skin are valuable signs. Muscular rigidity in
the lower right quadrant will be present, es-
pecially if there is any amount of periappendi-
citis. Perforation is accompanied by a more
•This paper, prepared a few years ago,’ was
.submitted *£>£cause of its unusual timely content.
Miss.
generous extension of tenderness over the low-
er abdomen and there is a definite decrease
in pain for a time until peritonitis sets in, when
there is increasing distention and pain with a
recurrence of vomiting. An appendiceal ab-
scess gives a sensation of rather firm solid
resistance on palpation and is accompanied by
a longer history. The urine should show no
pus cells; however, in a retrocecal appendix
lying close to the ureter, one often finds a
relative pyuria.
In the acute case one is often called upon
to rule out one or more of the following dis-
eases:
1. In salpingitis one may have a history of
Neisserian infection. The tenderness is lower
down, both sides of the lower abdomen are
tender and on vaginal examination there is
far more tenderness on moving the cervix.
Vaginal discharge and the gram-negative dip-
lococci are usually present in the secretion
of the cervix. The leukocyte count is usually
higher in salpingitis. The sedimentation time
may often be of great value in differentiating
the conditions. It has been found that the
sedimentation time for appendicitis is pro-
longed in the early hours and is very much
shortened as time passes. The opposite is
true in salpingitis. Early the time is short and
is much prolonged as the disease progresses.
2. In ectopic pregnancy there is usually a
history of a missed period and spotting. Pal-
pation discloses a mass and extreme tender-
ness on vaginal examination. Pallor and quick-
ened pulse are additional valuable signs in rup-
tured cases.
3. Intestinal obstruction has more abrupt
onset, more frequent vomiting with absence
of ^stools and flatus from the rectum. The
abdominal tenderness is more generalized and
the pain more severe.
4. Gallstone colic is accompanied by a his-
tory of dyspepsia, gas and possibly jaundice.
The pain and tenderness are in the upper ab-
domen and referred to the shoulder. The vomit-
ing is more frequent. ‘ -W.
5. In perforated ulcer one may find' a typical
ulcer history. The onset is more sudden, the
474
Appendicitis — Davis
November, 1945
rigidity of the entire abdomen is board-like
and the pain steady. Also there is decreased
liver dullness and a gas bubble ibelow the dia-
phragm. A1'
6. Renal colic is associated with frequency
of urination and possibly blood or pus in
the urine. The pain radiates down to the geni-
tal organs or thigh arid a 'flat plate of kidney,
ureters and bladder are apt to show a shadow
in the renal pelvic -or afong the course of the
ureter.
7. Ovarian lesion, such as a twisted ovarian
cyst, can usually be detected by vaginal enami-
nations, while a ruptured lutein eyst may be
difficult to rule out, except when there are
signs of hemorrhage present, when it stimu-
lates the picture of ruptured ectopic pregnancy.
8. Pyelitis, hydronephrosis and renal tumors
are eliminated by urine examination and pye-
lography, as well as palpation.
9. A spastic bowel gives a fairly typical his
tory of generalized colicky pain over a long
period of time, with frequent bowel move-
ment or passage of gas by rectum.
10. Mesenteric thrombosis is characterized
by a sudden onset of most severe pain. The
temperature may be high and blood is vomited
later. The tenderness is more generalized.
11. Acute infectious diseases such as pneu-
monia in children, measles, scarlet fever, and
influenza may be ruled out by history of ex-
posure, as well as the leukocyte count.
12. Acute pancreatitis is characterized by
a rapid onset, extremely rapid pulse, frequent
vomiting and collapse. The tenderness is high-
er in the abdomen than in a case of appendi-
citis.
13. Tabes dorsalis gives the typical neuro-
logic findings of frozen pupils, absence of
knee jerks and possible history of primary
lesions with a genital scar.
14. Inflammation of Merckel’s diverticulum
it not usually (Jiagnosed until after operation.
A McBurney incision should always be made
and the appendix always removed if possible.
The McBurney incision gives ample access in tf
most cases of appendicitis and can be en- ,
larged if necessary. Postoperative hernia of the
wound is much less likely to occur in the Me*
Burney incision. If is particularly adaptable in
the perforated case because in such cases the
wound should not be closed. One or two soft
rubber tubes or cigarette drains should be in-
serted and the peritoneum sutured lightly.
The rest of the wound is left open and packed
with gauze, soaked in mercurochrome, petrole-
um or something similar.
In the perforated cases physiological rest of
the gastro-intestinal tract is effected by limit-
ing the oral intake and avoiding proctoclysis.
In all cases of spreading peritonitis or where
a perforation or abscess exists, essential water
and electrolytes with some calories are given
intravenously by five per cent dextrose in
saline or Ringer’s solution. If there is disten-
tion, the stomach should be decompressed by
inserting a nasal tube to the stomach or duo-
denum and if the distention is great continuous
suction should be applied.
Gentle handling of the intestines with suc-
tion instead of gauze packs is important in pre-
venting spread or dissemination of the peri-
tonitis. Simple ligation, severing and disinfect-
ing of the stump is all that is necessary. In-
version is a waste of time.
In some prolonged cases, transfusions are
helpful or life-saving. Pasty edema with ane-
mia as a result of lack of intake of protein
foods, is the condition seen when transfusions
are valuable.
BIBLIOGRAPHY
1. Leitch, Neil: The Diagnosis and Treatment of
Acute Appendicitis and its complications, Minne-
sota Medicine , 22:735 (November) 1939.
2. Burger, Thomas C. : Problems in the Diagnosis of
Acute Appendicitis, California and Western Medi-
cine, 50:7 (January) 1939.
3. Reid, Mont R. and Montanus, W illiam P. : Appen-
dicitis; An Analysis of 1,153 Cases at the Cin-
cinnati General Hospital, Journal of the American
Medical Association, 114:1307 (April 6), 1940.
4. Smith, C. T., Harper, Thelma and Watson, Anna:
Sedimentation Time as an Aid in Differentiating
Acute Appendicitis and Acute Salpingitis. The
American Journal of the Medical Sciences, 189:-
383 (March) 1935.
5. Sprague, Edward W., Schaff, Royal A., MacAr-
thur. Clymont Hawkes, Stuart Z., Hantman
Harold and Haley, Paul W. : A Study of Appen-
dicitis. An Analysis of 1,463 Consecutive Cases.
Surgery, Gynecology and Obstetrics, 66:166 (Feb-
ruary 1), 1938.
6. de Bruine Ploos Amsrel, J. J. : Pneumonia or
Appendicitis, Ztschr. f. arztl. Fortbild 19:393,
1922.
7. Ray, Bronson S. : A Study of Appendicitis. 1500
Cases at the New York Hospital, New York, State
Journal of Medicine, 38:412 (March 15), 1938.
8. Collins, Donald C. : The Treatment of Complicated
iAcute Appendicitis, With Particular Reference
to the Ochsner Method, Medical Record, 150:127
* (August 16), 1939.
9. Horsley, J. Shelton, Horsely, John S., Jr. and
JLprsely, Guy W. : Appendicitis: Newer Methods
of Treatment, Journal of the American Medical
Association, 113:1288 (September 30), 1939.
0. Orr, Thomas G. : The Treatment of Acute Appen-
dicitis; Southwestern Medicine, 21:433 (December)
' : T937l ■ • -Ji . ■ . ■
1. Morse, Louis J. and Rader, Milton J. : Acute Ap-
pendicitis. A Twenty-Year Clinical Survey, Annals
November, 1945
Medical School — Nobles
475
of Surgery, 111:213 (February) 1940.
12. Manzade, Derwisch M. : Differential Diagnosis
of Appendicitis and Follicle or Corpus Luteum
Hemorrhage, Weiner Klinische Wr ochenschrift,
49.1393 (..ovember 13) and 1428 (November 20)
1933.
13. Mhnzade, M. D.: Differential Diagnosis of Appen-
dicitis and Hemorrhages from the Follicle and
from the Corpus Luteum, Wrien Klin W^chnschr.,
49:1392, (November 13) 1428 (November 20) 1936.
14. Foster, Allyn King, Jr.: Mesenteric Lymphaden-
itis. Report of Twenty-four Cases with Tabula-
tions Showing Relation to Appendicitis and Other
Diseases; Need of Surgery, 38:131 (January) 1939.
15. Nobel, Edmund: Appendicitis Peritonitis, WTciner
Klinische W ochenschrift, 48:596 (MaylO) 1935.
Should We Have a Medical School?
EUGENE R. NOBLES, M.D.
Rosedale, Miss.
We have hoped that some day Mississippi
would have a medical school. This present
urge, which began during the last campaign
for governor, I assumed like most of you, to be
political propaganda designed to get votes. It
represents progress, it involves building, edu-
cation, and medical service — these three sub-
jects being popular with the voters. A bill
was offered in the legislature for the pur-
pose of establishing a medical school. It was
defeated, first, because of the known difficul-
ties at that time in securing priorities for con-
structing and equipping buildings of this
character; and second, because of the con-
tention that this necessary delay would pro-
vide ample time for the legislature to ascer-
tain and assemble essential facts in regard to
Mississippi’s needs before launching a program
of such magnitude. This was agreed upon,
and a nationally known figure in the field of
medical education was employed to make the
survey. This survey has been completed and
made a matter of public record. •
The next time that I was impressed with the
importance of the subject was at a meeting
of the State Hospital Association the follow-
ing May. At this meeting in making a report
to the Association on the hospitalization of the
indigent, I stated among other things that the
time has come when because of paved roads
and increasing hospital facilities we are to
have fewer, but more efficient, doctors. In
the discussion of this report, one of the leaders
in the medical school movement talked at
some length upon the need for a medical school.
His talk had a certain amount of logic and
was fairly convincing at that time. The pre-
sident, a resident of Jackson, was quite en-
thusiastic. The Hospital Association, later
in the proceedings went on record as approv-
ing the plan for a medical school; and the
next day, with like speed, the Medical Associ-
ation did the same thing with almost no dis-
cussion.
This legislature will have another bill before
it when it convenes in January; and since
almost all the newspaper reports have been
favorable, I think it would be worth your time
to present to you, as an observer, an analysis
of the situation as I see it.
I believe that before we begin a program of
such far-reaching importance as the future
medical needs of the people of this state, we
should be reasonably sure that the time is
favorable and that we will accomplish our
aim with the money we propose to spend.
We all know that the supply of doctors in
Mississippi is diminishing and has been for
years, because new ones are not locating in the
state fast enough to replace the losses incident
to old age, disabilities and death. There are
some who propose to meet this demand by
establishing a medical school in Jackson. There
are others who believe it can best be done
by enlarging our present hospital system, and
still others who advocate a combination of
the two methods.
The original advocates of the medical school
plan embrace it under the benighted belief
that when a product becomes scarce and poor-
ly distributed, a factory should be started.
A good many have still not been convinced
that young graduates in medicine are not just
so much merchandise on the market.
There is another group, continually increas-
ing, who are employees, directly or indirectly
of the state, who are advocating it purely as
a political measure on this basis: You help me
with my project and I will help you with yours.
I have also observed that among the most
enthusiastic advocates of the medical school
plan are the very ones who steadily, through
the years, opposed the abolishing of the five
state operated hospitals which are known to
be a discredit to the state.
To those who do not belong to any of the
above groups, but who really think a medical
school will solve the problem, I would like to
quote a recent statement from the secretary
of the Council on Medical Education and Hos-
476
Medical School — Nobles
November, 1945
pitals: “I feel that there is no justification for
the establishment of a medical school in any
state on the grounds that the state lacks a
sufficient number of physicians. There
are other causes for the lack of physi-
cians which are primarily economic in origin.
This includes not only the income which can
be earned by a physician in the state con-
cerned or in a rural community, but also such
general economic factors as the quality of
schools, churches, and homes in the area in-
volved. Even though a medical school should
be established in a state with a deficiency of
physicians, there is no assurance whatsoever
that the graduates will practice in needy areas
since presumably the establishment of the
school will in itself not correct the other
factors which I have mentioned.” Other na-
tional figures in the field of medical education
have made similar statements.
It takes more than money and enthusiasm
to establish and maintain a class A medical
school. There are only FOUR cities in the
United States the size of Jackson in which are
located medical schools. In no one of these
cities is the clinical material needed for teach-
ing purposes provided. Sufficient acute cases
to meet the teaching requirements have to be
transported from great distances at consider-
able cost. Medical education is by far the
most expensive form of professional training,
requiring an initial outlay, and subsequent an-
nual budgets in the early years, totaling mil-
lions of dollars, and not tens or hundreds of
thousands.
It will cost the state of Mississippi five
million dollars to build a medical school and
a hospital of sufficient size to meet its clinical
requirements, and a million dollars a year to
operate it. This last amount is broken down
approximately as follows: $350,000 for the
school itself, $500,000 for the hospital, $100,-
000 for the out-patient department, and at
least $50,000 for research. These figures of
course may vary from year to year, but mostly
upward rather than downward. This is $180,-
000 more than is spent at present on all of
the other state educational institutions of
which there are seven, or four times the pre^
sent annual cost of maintaining the University
of Mississippi.
The growing scarcity of doctors in the rural
sections is neither unique nor peculiar to our
state. The trend throughout the country for
the past twenty-five years has been from the
rural sections to the urban centers. This
trend began with the improved standards of
medical education initiated by the Council on
Medical Education and Hospitals, when be-
tween 1915 and 1920, 75 out of a total of 166
medical schools were forced out of business
by publicizing their low teaching standards*
This campaign did not lower the number of
medical graduates per year except for the
first few succeeding years, and it definitely
improved their quality.
The modern doctor requires hospital facili-
ties, and he will not locate where these are
denied him. There is actually not much rela-
tion between the presence or absence of a
medical school in a state and the number of
physicians to be found there. This situation
is essentially the same in states with two
medical schools, and Florida, with no medical
school, has 108 physicians to 100,000 popula-
tion as against Mississippi with 61. There are
twelve states without even a two-year medi-
cal school that rank far higher than Mis-
sissippi in the proportion of physicians to
population.
I wish to contend to you that any sensible
program of construction contemplates building
from the ground up rather than from the roof
down. I believe that we are about to be
rushed into a costly program of medical educa-
tion for which we will not be ready for many
years.
The problem of modern medical care in oui
state is not a simple one when we contemplate
that ultimately all the people are to receive
the benefits at a price that they can afford. It
will take many years to develop such a pro-
gram, for there are a good many deficiencies
and many reasons why these deficiencies exist.
Fundamentally .they develop from the fact
that this is a rural state, with no large cities;
our annual per capita income is the lowest in
the nation, and one-half of our population is
Negroes. These problems are essentially eco-
nomic, rural, Negro. These are the basic rea-
sons for the doctor shortage, not the lack of
a medical school. For example, if the Negro
population is left out of the count, Mississippi
takes a high rating in the physician-population
ratio with 141 physicians to 100,000 popula-
tion as against the national average of 125.
There are a million Negroes in Mississippi and
qnly 52 Negro doctors. This large Negro popu-
lation has also placed Mississippi at the bottom
November, 1945
Medical School — Nobles
477
of the list of states, educationally, economical-
ly and in public health requirements, and a
natural question is, What are we going ' to
do about that?
The first corrective step in this program
of medical care should be the further develop-
ment of our community hospitals, primarily
by more liberal support from the state, and
by encouraging public ownership by munici-
palities, counties, or hospital districts com-
prising even several counties or parts of coun-
ties. Enabling acts have already been passed
by the legislature. Tunica, Coahoma and
Quitman counties are planning through bond
issues to build a fine hundred-bed hospital in
Clarksdale in the immediate future. These
counties are recognizing the trend and are
preparing for it; others will follow very soon,
without a doubt. The poorer and more re-
mote areas must receive assistance and
grants from the state and federal govern-
ment. Although the privately owned hospital
has served a most useful purpose, (as a mat-
ter of fact, I think a monument should be
erected to the brave men who pioneered in
this field) its J day is rapidly passing, just
as the privately owned school did twenty-five
years ago. Hospital construction and main-
tenance is a public responsibility; and, in the
foreseeable future, the kind of medical care
any community receives will depend upon the
hospital facilities it offers. These hospitals
will furnish a nucleus around which will de-
velop medical centers that will determine the
quality of their medical talent, for young
men will be attracted to them as the demand
grows for their service. Small cities of less
than 5,000 population without hospital facili-
ties will be without medical service, as soon
as the old doctors die. As far as bringing
modern medicine to the crossroads, that is
a pure hallucination. In the very near future
the crossroads will have to be transported
to the doctor.
As Exhibit A in this contention let us pre-
sent the richest rural county in the world,
fifth from the top in taxable wealth in Mis-
sissippi, our own Bolivar. Within the ’ last
twenty-five years — a quarter of a century —
only eight doctors have located here directly
from their internships, with the view of estab-
lishing practice. All of these have left the
county except three who are located in Cleve-
land, where good hospital facilities are being
provided, Our sister county, Sunflower,' eighth
from the top in taxable wealth, has had a
similar experience. Her young doctors are
concentrated at Indianola where the hospital
facilities are. I think it worthy of comment
to note here that the greatest single step our
state ever made toward providing medical
care for the people was in 1936 when the
legislature passed the per capita bill. This
fund went a long way toward relieving the
small hospitals of their indigent load, it re-
stored confidence to them, and greatly im-
proved their efficiency. It is true that they
have made more progress during the nine
years this fund has been available than all
the other previous years of their existence.
It was directly responsible for the construc-
tion of the hospital here in Cleveland, in
Indianola, in Rosedale, and in other places in
the state. It rejuvenated many more. This
program should be stepped up by encouraging
public ownership of small hospitals and by in-
creasing the support given them by the state.
They are the very foundation, the very grass
roots, of any plan for state-wide medical serv-
ice. Most of the privately owned hospitals
will, in a few years, be on the market as the
present owners pass on. Young doctors have
neither the disposition nor the money to in-
vest in them.
Along with the development of the com-
munity hospital, the legislature, after first
abandoning the present five state operated
hospitals, should appropriate funds to be
matched with federal funds wherever possible
and build four regional hospitals with a capac-
ity of not less than 100 beds- — one in each
supreme court district and one in the Delta.
These hospitals would be staffed by local phy-
sicians as far as possible, open to all reputable
physicians, meeting all the requirements for
internship and residences, forever removed
from politics, where all classes of people can
be served, the rich, the poor, and the indi-
gent.
It is a mistake for the state to encourage
pauperization of its citizens and deny to any
of them the advantages which would accrue
from a properly managed, properly supported
state institution, for every patient who is ad-
mitted to a hospital makes a contribution
toward the improvement of medical service
that all the people in that town or city or
community receive. These district hospitals
would serve as reference hospitals for certain
special services and special cases originating
478
Medical School— Nobles
November, 1945
in the local hospitals in their territory. Their
functional relationship with the smaller hos-
pitals would grow and develop with the in-
crease in service and population so that finally
in the not too distant future the one which
naturally would be located at Jackson would
undoubtedly develop clinical material for an
acceptable teaching institution, for it is a
growing city.
They should be locally controlled, that is,
by districts, each being a separate entity in
this respect. They should be maintained by
local funds from city and county and any
needed assistance from the state-aid fund, plus
fees received from patients. These hospitals
are to be an integral part of the districts they
serve, open to all citizens alike who as patients
would have the right to choose their own phy-
sician. They would thus stimulate civic pride
because of the local support, local control
and would be the best answer I know to
threatened socialized or federalized medicine.
Second, in this plan, there should be en-
couraged and developed right along with the
development of the hospital system, a means
to educate the people to the value and need
of good medical care, and how and when
to use hospital service. This should be done
through the various avenues of publicity
available in the respective communities. A
lot of people still believe that a hospital is
the place where one goes to die, and they are
afraid to patronize it. This educational cam-
paign should be well planned, well publicized,
and constantly functioning to be properly ef-
fective.
Third, a better and more convenient method
of paying for this service must be devised
such as further development of pre-payment
plans, group hospital service plans, the Blue
Cross, the Blue Shield, and various types of
regional or local plans should be encouraged
and promoted.
The Negroes, through fraternal organiza-
tions, have developed a pre-payment plan for
hospital service. They have hospitals at
Yazoo City and Mound Bayou, both of which
are doing satisfactory work. Such programs
should receive our full endorsement and sup-
port. The state-aid hospitalization fund
should be continued with provisions made for
partial payments whenever the patient can
afford it.
I repeat: The 'State should not encourage
pauperization of its citizens. People should be
required to pay according to their means.
I have presented to you the problem of
medical care in Mississippi as primarily eco-
nomical, rural, and Negro. I have tried to
show to you with enough facts to be reason-
ably convincing, that the need now is 1) for
increased hospital facilities, 2) a sustained
educational program and 3) for the develop-
ment of pre-payment hospital service plans,
together with complete or partial state sup-
port for the indigent, as required.
With this program which I have briefly
outlined well on its way to realization, the
medical personnel will naturally follow, as
the day follows the night; but it will take
years for it to be accomplished under state
guidance. However, necessity will speed the
day. Meanwhile, to meet the immediate
shortage of doctors the state should subsidize
about 25 scholarships and make them avail-
able to qualified applicants on condition that
they return to the state to practice for a
predetermined number of years.
One advocate of the medical school plan
warns that it will take an Act of Congress
to get a scholarship out of a medical school.
But remember, one-third of the medical stu-
dents in the country are regularly non-resi-
dents of the state where they are attending
school, and I am in a position to know that
just four schools, all in neighboring states,
have been contacted, and three looked with
favor upon the scholarship plan.
The current cost to the taxpayers of the
state for each medical student graduated will
be $5,000 assuming that the tuition fee
averages $250 a year for residents. I submit
to you that when we return to normal times
and normal thinking, when the flow of oil
has diminished to a trickle - it always does -
the resources of this state will not afford
both of these programs; the medical school
and the hospitalization system. Which do you
think will accomplish the most good for the
people? As a matter of fact, how is an ac-
credited medical school to function satisfactor-
ily without dependable outlets for internships
and residences? Much has been said about
peddling our second-year students, but noth-
ing has been mentioned about peddling the
graduates. To these we will have an even
greater obligation. If we had fifty, or even
twenty-five, high grade internships available
within the state, we doubtless would have no
shortage of doctors ; for it is a common ob-
November* 1945
479
servatkm that where a young graduate serves
his internship has a much greater influence
on his selection of a location than where he
takes his degree in medicine. Our boys will
leave the state to serve their internships. Will
they return ? Experience in other states
gives a negative answer. High grade intern-
ships are prize possessions for young gradu-
ates in medicine and they are not easy to
obtain.
Alabama, with fifty prospective graduates,
has fifty-one approved internships. Arkansas
graduates between fifty and sixty each year
and has twenty-five internships. Louisiana
with 225 graduates has 250 internships and
Tennessee 166 white with 122 white intern-
ships. The overall picture, therefore, in our
neighbor state is 502 graduates with 448 in-
ternships; obviously there will be no surplus
available to us from these sources.
A graduate in medicine knows that an in-
ternship has more to do with developing his
talent than his training in school. Where
will these boys be placed ? Will we not be
petitioners for favors from many hospitals,
instead of a few medical schools? What will
we have to offer in the way of reciprocity?
These are just a few of the questions that
ultimately will have to be answered. I as-
sure you there are many more, but the funda-
mental fact remains that if we wish to at-
tract medical graduates to the state and ex-
pect to hold those who may take their train-
ing within the state, high grade internship
and residences must first be provided.
I have noticed what a splendid background
and an irresistible temptation this program
of medical education has offered to the well-
wishers, do-gooders and bleeding hearts in
appealing to the emotions of our people and
they have done beautifully as some of the
press reports indicate, but the cold, sound,
economic fact is that we have got the cart
before the horse by advocating the construc-
tion of a 500-bed hospital and medical school
in Jackson at a cost of five million dollars,
that will cost a million dollars a year to
keep up, which will be a great measure de-
pendent for clinical material and outlets for
internships and residences upon a well de-
veloped hospital system in the state that does
not even exist. In these post-war years, dur-
ing which time we are certain to see burden-
some taxation and diminished incomes, ex-
travagant expenditures both by the states
and federal government, must by necessity
come to an end. When they do, in our state,
there is a real danger that the proposed
medical school may become a memorial to
our shortsightedness.
DR. HENDERSON PRESIDENT-ELECT OF SOUTHERN
Dr. M. Y. Dabney, Birmingham, Ala.,
who was named president-elect a year ago in
accordance with the Southern Medical Asso-
ciation’s custom of electing its presidents a
year in advance, was installed as president,
succeeding Dr. Mastin.
After receiving a nominating report from
its council, the association unanimously elect-
ed Dr. Elmer L. Henderson, Louisville, Ky.,
as the new president-elect. Other officers
chosen without opposition were Dr. Lucian
A. LeDoux, New Orleans, first vice-president,
and Dr. Oscar W. Frickman, Newport, Ky.,
second vice-president.
Dr. Neil Moore, St. Louis, was named
chairman of the executive committee and Dr.
W. Raymond McKenzie, Baltimore, chairman
of the council.
The association’s Research Medal, award-
ed ten times since 1913 for outstanding work
in medical research, was presented to Dr.
Tinsley R. Harrison, professor of medicine
and faculty dean of Southwestern Founda-
tion Medical College, Dallas, Tex. The
award was made in recognition of Dr. Har-
rison’s contributions in the functional aspects
of heart disease and problems arising from
failure of circulation.
A Past-President’s Medal was awarded
posthumously to Dr.Edgar G. Ballenger, At-
lanta, Ga., who died during his term as presi-
dent in the last year, and a similar medal
was presented to Dr. Mastin, who succeeded
him.
Other speakers at the session were Dr.
Frickman; the Rev. William Dern, pastor of
St. Paul Episcopal Church, Newport, who de-
livered the invocation; Dr. Oscar O. Miller,
Louisville, who welcomed the physicians on
behalf of the Kentucky State Medical Asso-
ciation; Dr. J. Warren White, Greenville, S. C.,.
and Dr. Roger I. Lee, Boston, president-elect
of the American Medical Association.
480
Editorials
November, 1945,
The Mississippi Doctor
Published monthly at Booneville, Mississippi
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 187u. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
» Official Organ Of
Mid-South Postgraduate Medical Assembly
Mississippi State Medical Association
W, H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
Mid-South Postgraduate Medical Assembly
Officers :
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M. D ....Vice-President
El Dorado, Ark.
A. F. Cooper Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis. Tenn.
Editors :
C. R. Crutchfield, M. D. E. M. Holder, M.D.
H. King Wade, M. D. F. M. Acree, M.D.
Mississippi State Medical Association
Editor
Lawrence W. Long, M.D.
Associate Editors
J. G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life , Building,
Jackson, Mississippi. '~
WHY NOT IN MISSISSIPPI?
I have read the article in your issue of
October 23, under the heading of “Talk of
the Nation” on the subject of “Medical Edu-
cation” condensed from the Richmond Times-
Register.
It appears that this newspaper was much
perturbed in learning that Mississippi is con-
templating the establishment of medical fa-
cilities somewhere within the state which
will supplement the two-year medical course
now offered at the University of Mississippi.
The editor then suggests that the policy of
Virginia be followed and states there is no
sound reason why arrangements cannot be
made with Tulane, Louisiana State Univer-
sity, or Vanderbilt to take the Mississippi
students after they have completed their first
two years. However, in order for Tulane or
LSU to accept all the students from the school
of our sister state, it would probably mean
they would be compelled to lessen the num-
ber in the freshmen and sophomore classes
and increase the number in the junior and
senior classes. This, no doubt, would work
a hardship on any medical school, and does
not sound logical. Furthermore, as stated in
a recent editorial in the Mississippi medical
journal, “Mississippi is financially able to own
and operate a medical school if it wants it.”
Everyone will agree that Virginia is to be
complimented on the brotherly love it is
exhibiting for a state so far away. But, from
all reports it appears that the article appear-
ing in the Richmond paper is prompted by an
adverse report on Mississippi’s proposed four-
year medical college and hospital center by
Dr. W. T. Sanger, president of the Medical
College of Virginia. Ex-Governor Hugh
White of Columbia scathingly denounced this
report before the Jackson Exchange Club and
to heads of fourteen state-wide organizations
declaring, “I’ve read this report ten times
and the more I read it the more disgusted
I get.”
The School of Medicine at Augusta, Geor-
gia, organized in 1828, which is part of the
University of Georgia, has been very success-
ful. The University of Texas has operated
a medical school at Galveston since 1891. The
population there is limited, making the clini-
cal material likewise. The medical college
of the state of South Carolina at Charleston
graduated its first class in 1825. All are four-
year schools.
Therefore, with the first two years pro-
vided at Oxford, it does sound feasible for the
state of Mississippi to establish a medical
school in one of its large cities to take care
of third- and fourth-year students.
According to the 1940 census, Jackson, Mis-
sissippi, had a population of 62,107 — Augusta
65,919 — Galveston, 60,862, and Charleston
71,275. So, by comparison it appears that
Jackson would be the logical place for a two-
year school.
The medical schools of the United States
481
Editorials
November, 1945
are overcrowded. Some schools have four
times as many applicants as the number they
are able to accept. So many young men with
the ambition to study medicine are turned
away owing to the lack of facilities.
Quoting from the editorial page of the
Mississippi Doctor (September, 1945) this may
be a thought to leave with the Times-Register :
“The four-year medical school, the medi-
cal school hospital, and the state hospital
system are as the driver, the vehicle and the
motive power of a planter. It takes all three
to get the job done. The four-year school is
the driver, the doctors, nurses and interns in
and out of training, constitute the power, and
the hospital system with its equipment is the
vehicle in which the service is delivered. It
seems now that it is time for Mississippi to
own and till her lands and quit working on
the shares.”
— N. R. Shubert
We deeply appreciate the above from Mr.
N. R. Shubert in a recent issue of the New
Orleans Item. Mr. Shubert is a well-informed
and a fair-minded man. It seems very
strange that Virginia with a population just
a bit larger than ours and with two medical
schools should be so positive in saying that
we should not have a four-year school. We
haye the funds for a four-year school, but
evenso it is the medical spirit that really
makes the school. The big medical schools
have overshot the mark in medical education.
Their graduates do not know how to prac-
tice in the small town and rural community
and they are not inspired with any missionary
spirit to do so. We need at least one medi-
cal school in the United States that can give
an adequate, practicable course in everyday
diseases that ninety per cent of our people
have died of and will continue to die of, and
imbue the students in this school with the ideal
of a professional mind, a medical soul, and a
missionary heart.
As doubters we have already wandered
in the wilderness for forty-two years and it
is now high time that we go forward and
possess the promised land in medical service.
It is rich unto harvest and a land offering
wonderful opportunities.
The Southern Medical Association meet-
ing at Cincinnati was a fine success. It is
hard to say how large the attendance would
have been had the hotel accomodations been
unlimited. Dr. Mastin of Saint Louis, a great
grandson of Dr. Ephriam McDowell, presided.
He became president on the death of Dr.
Ballinger of Atlanta. Dr. E. L. Henderson of
Louisville, Kentucky, was elected president-
elect, and Dr. M. Y. Dabney of Birmingham
was installed as president. Drs. W. W. Craw-
ford, Felix J. Underwood, and Harvey Garri-
son gave Mississippi a hundred per cent at-
tendance of past-presidents of the Southern
in point of service, Dr. W. S. Leathers, dean
emeritus of Vanderbilt, also served as president
from Mississippi. Dr. J. P. Culpepper, council-
or for Mississippi, was advanced to a place
on the executive committee at the meeting.
It is remarkable that the Southern went
through the duration without missing a meet-
ing. It kept medical information liquid and
flowing to the doctors and in turn to the
people. This credit is largely due to the able
secretary-manager of the Southern, Mr. C. P.
Loranz.
The place of the next meeting is not yet
decided, but it will probably go to the grand
old Southern city of New Orleans.
We deeply regret the going of Doctor F.
F. Young, Fenwick (Sanitarium, Covington, La.
It was not our pleasure to meet him, but he
was among our first advertisers in the Mis-
sissippi Doctor, and through the years our
business relations were most cordial. He was
generous, appreciative, and prompt, a kindly
dependable friend. We are sure that the sons
will carry on in a fine way. He seems to have
endowed them with all the fine traits of a
worthy father.
NOT DEMOCRACY
The following protest from overseas medi-
cal personnel has been received by deans of
medical colleges, secretaries of state medical
associations, individual leaders and periodicals
in the profession. Its distribution represents
an effort to arouse the profession to the in-
justices of the point system, and the dangers
which threaten when organized medicine at
home becomes lethargic toward the lot of men
kept overseas where their services are no
longer needed.
A similar declaration from Navy men on this
side follows. Situations such as this should
not continue unprotested.
482
Editorials
November, 1945
France,
9 November 1945
There are existing at this time in the Euro-
pean Theatre of Operations, conditions which
are the seedlings for planned changes in the
future practice of medicne. They have been
present all during the actual war and were
the stimulus for many thousands of rightful
“gripes” by the doctors in the service. Now
that the war is over these injustices are still
present, and it is high time that they be aired,
so as to preserve our present standards of
medical practice and thus continue to insure
the American people the highest degree of
health.
We are writing this letter to you to ac-
quaint you with these conditions which are
planned adjuncts to the collaring and slow
choking of the American medical profession.
1. Much has already been said and written
concerning the surplus of doctors in service,
and the hoarding of this surplus by the mili-
tary. This unnecessary disproportion was
present, but tolerated, during the actual time
of combat. At that time there was one doctor
per two hundred soldiers. From the available
casualty figures published by the Army and
Navy, during the entire European and Pacific
war, there was available one doctor for every
ten soldiers injured. Compare this figure
with the civilian figure where one doctor
serves one thousand people of all ages and of
both sexes. Now with the war over, combat
casualties non-existing, the redeployment of
the troops “excluding medical officers,” this
disproportion grows even more alarming and
ridiculous. We find ourselves with no work
to do sitting idly here, simply political prison-
ers. Is this not a sufficient contradiction to
the plea of “necessary” to arouse in us a sus-
picion and fear of a sinister plot of the greedy
social planners? Do we read socialized medi-
cine in the offing? We are sure we do. We
don’t like it. We don’t want it.
2. A second inciting factor of the present
medical situation is the policy of the Army to
refrain from inducting into the service those
young men who were given a medical and
dental education at the expense of the Gov-
ernment. These young men are not being
sent overseas as replacement, while doctors
with 15 to 24 months overseas service or two
to three years total service are being kept
here, many to serve in the Army of Occupa-
tion. This contradiction to logic, this breech
of everything that is right, just, and holy is
leaving a mark of bitterness in us doctors that
even time will not erase. We ask, “Is the -
Army keeping the older men, those with long-
overseas service, away from the States to*
curry favor with the younger men in the hope
and play of entwining them in their scheme of
socialization ?
3. Along the same line, doctors at home,
who have never left the States are being dis-
charged with fewer points than many doctors
have who are overseas. They are being dis-
charged, and we can’t even get home. Again
we ask ourselves a question, “It this justice,
or are we making a mistake by expecting
justice?”
The results of these injustices is becoming
very evident to us who are witnessing these
experiences. The doctor has no work, he is
loafing, he is losing his initiative, his desire
for and interest in medicine. He is develop-
ing a mental attitude which if it continues to
be nourished by instances as above,, willj
solidify into a bloc, not only willing to accept,
but encouraging socialized medicine. This is
not an idle dream, this is now an everyday
conversation and admission, spoken no longer
with hesitancy, nor with shame, and with less
and less regrets. The future is not rosy. Is it
the desire of the representative leaders of our
profession to see as a result of this neglect,-
an embittered bloc of medical people arise?
A bloc so frustrated that the advent of socializ-
ed medicine would be welcome refuge. We
think not, and we hope not. Unless something
is done immediately, these grave fears will
come to pass.
In an effort to avoid this we offer the fol-
lowing suggestions:
1. Let there be adequate medical personnel
for American soldiers in each theatre. No
more, no less.
2. Get the surplus of those overseas home
immediately. There is an overwhelming sur-
plus. Get those with long overseas service
home now. They can’t take much more now.
3. Let the A. S. T. P. and V-12 doctors earn
their government education by a tour of duty
overseas thereby allowing the poor, forgotten,
disillusioned, lethargic doctor a chance to re-
turn home because he is now filled with ennui
such that he doesn’t know if he is coming or
going!
4. The American Medical Association should
pursue its function of protecting the rights of
its members. Let us not again see the Journal
November, 1945
News and Comment
483
repeat, without criticism, the exorbitant de-
mands of the Army. It nauseates us who
know the true state of affairs^ and is an in-
sult to our intelligence.
5. We think too that after the cessation of
hostilities there ought to be at least a degree
of medical autonomy. A representative com-
mittee of the profession should have the pow-
er to decide how many doctors for the mili-
tary and how many for the civilian population.
The future of individualistic American medi-
cine is in the balance. You can tip the scales
in the right direction. But it must be done
now.
U. S. Naval Amphibious Training Base
Fort Pierce, Florida
Editor
The Mississippi Doctor
Booneville, Miss.
Dear Sir:
I note that the Army is automatically dis-
charging medical officers who are over 48
years of age, irrespective of how many “points”
they have.
The Navy has no such provisions for the
discharge of their medical officers. This is
manifestly unfair. I wonder if you will use
your influence to get the Navy to adopt the
same over-age rule, and in 1945?
Trusting to hear from you soon.
Yours very truly,
James E. Fisher
News and Comment
POSTGRADUATE COURSES
The Tulane School of Medicine, Department
. of Graduate Medicine, New Orleans, Louisiana,
will again offer short postgraduate review
courses during the coming session. The dates
for these will be:
Pediatrics — December 10-14, 1945.
Obstetrics and Gynecology — January 14-18,
1946.
A number of scholarships for general prac-
titioners have been arranged through the Mis-
sissippi State Board of Health covering tuition
($25), transportation, and a daily stipend of
$6.00 to cover room and meals.
Mississippi physicians who would like to
take advantage of these courses are invited
to apply to Dr. Felix J. Underwood, executive
officer, Mississippi State Board of Health, at
the earliest possible date.
ANNOUNCEMENT
Dr. Fred M. Sandifer, Jr., formerly Medical
Corps, Army United States, announces the
reopening of his office 110 E. Market Street,
Greenwood, Mississippi. Fellow American Col-
lege of Surgeons, Diplomate of the American
Board of Surgery.
GERIATRICS
The new bi-monthly medical journal, Germ-
tries , devoted t)o research and clinical reports
on the processes and the diseases of the aged
and aging, will appear in January, Modern
Medicine Publication announces.
The editor is Dr. A. E. Hedback, who has
been the editor of Modern Medicine since its
inception. The editorial board serving with
Dr. Hedback consists of a group of distinguish-
ed and medical authors and editors, special-
ists in the field of geriatrics.
RESOLUTION
Whereas , the facilities and appropriations
at the Mississippi State Hospital at Whitfield
are woefully inadequate to provide the bare
necessities of life for the inmates, and ;
Whereas , this institution is, and will con-
tinue to be, required to provide care for an
ever increasing number of unfortunate citi-
zens of the state that will have to be under
state protection and care, therefore
Be It Resolved that we, the members of
the Delta Medical Society, urgently recommend
the approval of Dr. C. D. Mitchell’s request
for additional facilities and appropriations.
Whereas , the control of the management
of the Mississippi State Hospital at Whitfield
being under the changing state executive ap-
pointment and jurisdiction; and
Whereas , the term of office for the medi-
cal appointments is for 4 years only and such
appointments are not conductive to the best
interest of the medical standards or manage-
ment of the institution, therefore
Be It Resolved that we, the members of
the Delta Medical Society, recommend that the
Mississippi State Hqspital be placed under
civil service guidance and protection; and the
superintendent and other medical appoint-
ments remain in office for an indefinite length
of time according to their abilities and quali-
fications.
484
Deaths
November, 1945
Deaths
DR. s. s. CARUTHERS
Dr. S- S. Caruthers, former physician of Duck
Hill, died Monday morning, November 12, at 4:00
o’clock at his home in California.
A memorial service honoring Dr. Caruthers was
held* in Duck Hill at 4:00 p. m. November 14, with
Rev. A. W- Bailey, pastor of the Webb and Sumner
churches, conducting.
DR- W. J. COLEMAN
Dr- William J Coleman died at Baptist Hospi-
tal. Memphis, Tenn., Tuesday and was buried in
Aberdeen, Miss-
Dr. Coleman, 61 years old, practiced in Aberdeen
for more than 25 years, and retired 13 years ago
because of ill health. He received his medical degree
from Jefferson Medical College, Philadelphia. He
is survived by his wife, Mrs. Bertha M- Coleman-
DR. CLYDE M- SPECK
Dr. Clyde M- Speck, physician and surgeon,
died at the New Albany Hospital November 9 of
complications following an appendectomy the pre-
ceding Sunday.
Services were held at the New Albany Presby-
terian Church and conducted by Dr. J. P- Kirkland
of Walnut, Miss-, and Dr. J- R- Davis of New Albany.
Dr. Speck graduated from Vanderbilt University,
and practiced in Blue Springs and New Albany.
He helped found the New Albany Hospital, was a
member of the Northeast Mississippi Medical Society,
the Mississippi State Medical Association, and the
Southern Medical Association, and the Mid- South
Postgraduate Medical Assembly (past-president.)
He is survived by his wife, Mrs- Carrie Mayes
Speck, one daughter, Carolyn Speck, three brothers,
Scott H. Speck, L- E. Speck, and J- Doss Speck,
all of Blue Springs.
DR. B- A. VOWELL
Following an illness of long duration. Dr. B. E-
Vowell died at his home in Carthage, October 17.
He had been in declining health for many months-
He was a native of Winston County, Mississippi,
born in 1892. He took his medical course at Uni-
versity of Tennessee, graduating in 1912, and located
the same year at Columbus for the practice of medi-
cine. He later practiced his profession at Mary dell,
Edinburg and Carthage, having moved to Carthage
five years ago.
In 1915 he was married to Miss Lillie, Jordan, of
Marydell, who survives him- He is also survived by
nnn son, Vaughn, with the Seabees in the Pacific
for a number of months and now stationed in Rhode
Island, and three daughters, Mrs- Rupert Smith,
Edinburg: Mrs. James Franks, Carthage, and Mrs-
Mahlon Webb, University, Miss- He leaves eight
grandchildren.
DR- H- S- GOODMAN
Dr. Henry S- Goodman, 71, prominent Delta
physician, died at his home in Cary October 24,
following an extended illness.
Until forced to retire due to ill health, he had
practiced in Cary and vicinity for the past forty
years. He was a graduate of Virginia School of
Medicine.
Dr. Goodman was a member of the Goodman
Memorial Methodist Church, a Shriner, a member
of Issaquena- Sharkey- Warren Counties Medical So-
ciety and of the Mississippi State Medical Associ-
ation-
He is Survived by two daughters, Miss Ethel
Louise Goodman, Cary, and Mrs. Henry Greerr
Anguilla: one son, Dr. H. B- Goodman, Anguilla, and
a brother, ^Commander Rex Goodman, LT. S. Navy,
New Orleans.
. . . • r >
DR. W.’*A. WILLIAMSON
Dr. William Arthur Williamson, 75, who lived in
Duffee, but was engaged in most of his medical
practice in Meridian, was killed October 26, when
struck by a Gulf, Mobile & Ohio freight engine in
Duffee-
Dr- Williamson was born in Newton County, was
a .graduate of Memphis Medical College and moved
back to Duffee. He was known for his many acts of
charity and kindness. The doctor was a member of
the Suqualena Masonic Lodge, and the Duffee Bap-
tist Church.
He leaves his wife, Mrs. Belle Freeny Williamson;
and Miss Tommye Williamson, Duffee; three sons,
two daughters, Mrs. J. G. Byard, Oak Ridge, Tenn-,
Donald, Camden, Miss-; Charles D., Duffee and J-
Sherrill Williamson, Tuscaloosa, Ala., and 11 grand-
children.
DR. A. W- DUMAS, SR-
Dr. A. W- Dumas, Sr., was born in Houma, Louisi-
ana, Sept- 9, 1876- Early instruction was received
at Houma Academy and Flint Medical College. He
graduated from Illinois Medical College, which is
now part of Loyola University, Chicago, III., in 1899,
receiving the degree of Doctor of Medicine. He died
in Natchez, Oct. 1. * •‘T-
He began the practice of medicine in Natchez,
November 16, 1899, and spent his entire active life
there. Dr- Dumas in his career had a very large
practice and through the years built up a reputation
of competence and kindliness.
A good example of this is his organization of the
Poor Colored Children’s Christmas Tree which for
thirty years has enjoyed the support of the people
of Natchez, and each year money is sent from all
parts of the country by former residents who know7
of the joy that this endeavor brought into the homes
of the poor of the community.
In 1940 Dr. Dumas was honored by being drafted
into the presidency of the National Medical Associ-
ation. In the same year, Campbell College conferred
on him the, degree of Doctor of Humanities.
In 1943 he was appointed a member of the Medi-
cal Advisory Committee, Children’s Bureau, Depart-
ment of Labor United States Government, in wdiich
capacity he served until his degth- He is a member
of the Omega Psi Phi Fraternity — Lamba Alpha
Chapter, and Rose Hill Baptist Church.
Surviving Dr- Dumas are: his widow, the former
Cornelia Marcella Harrison, and nine childen :
Cornelia Marcella Harrison, and nine children, twrelve
grandchildren ; and a brother, Dr- Henry Dumas.
Natchez.
FOR SALE: Physician’s office equipment, in-
struments, books, microscope, blood pres-
sure machine, etc. All in good condition.
Mrs. S. F. Hill, Macon, Miss.
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Ped:atrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — V/. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
DERMATOLOGY
Archives of Dermathology and Syphilology,
V. 51; N. 6; June, 1945. p. 405
Review of 2,144 Courses of Rapid Treatment
for Early Syphilis.
E. W. Thomas and Gertrude Waxier, Am. J.
Syph., Gonor. and Ven. Dis. 28:529; Sep-
tember, 1944.
The authors started the rapid treatment
. of early syphilis at Bellevue Hospital in De-
cember 1939. The most effective method with
mapharsen alone during a period of from five
• to ten days required a total dose of over one
gm. When it was given in amounts which ap-
preciably exceeded one mg. per kilogram of
body weight on any one day the incidence of
arsenical encephalopathy was more than one
per cent. In the administration of 909 such
courses of treatment each lasting from six
to ten days, three deaths occurred. In a series
of 1,046 courses of treatment, each consisting
of daily injections of mapharsen in doses of
about one mg. per kilogram of body weight
and four fevers induced by typhoid vaccine
during a ten-day period, there were only three
cases of mild arsenical encephalopathy and
no deaths. In a total of 2,144 courses of rapid
treatment the incidence of encephalopathy was
higher among men than among women. Re-
sults of quantitative serologic tests during
and after the administration of rapid treat-
ment suggest that reagin may be introduced
for varying lengths of time after the spiro-
chetes have been eradicated. In general, the
longer a patient has had syphilis the longer
485
it is before the serologic reaction for syphilis
becomes negative. Of all the patients followed
for six months or more after treatment, 80
per cent demonstrated results that were con-
sidered to be satisfactory. If the patients who
were retreated are included 85.6 per cent had
results that were considered to be satisfactory.
The low incidence of positive spinal fluid find-
ings from six months to four years after rapid
treatment is encouraging. Neurorecurrences
after rapid treatment have been fewer than
after routine treatments. A few patients were
treated according to a plan of therapy devised
by Eagle, in which three injections of map-
harsen were given each week during a period
of from six to eight weeks. Difficulty was ex-
perienced in persuading patients to complete
the course of treatment and to report reg-
ularly; hence the number of patients treated
was too small for evaluation.
PEDIATRICS
The Care of the Premature Infant from an
Obstetrical Standpoint — Johnson, Robert A.
— Texas State Journal of Medicine, 41:5 (May)
1945.
The author of this article is no doubt a
recognized physician and obstetrician with
ability. I commend it to the profession of the
state to be read and weighed in the light which
it is given. The following quotation from this
article may be read with interest and profit
by the practitioners of this state. “The ob-
ject of the obstetrician is two-fold, first, to see
that the expectant mother passes through the
period of gestation safely, and second, to aid
in carrying the product of conception a suffi-
cient length of time so that after its expulsion
the newborn is alive and healthy for at least
six weeks. Thereafter the responsibility of
the infant rests with the pediatrician. The
greatest risk occurs to the infant during the
first two days of life as shown by the fact
that approximately 70 per cent of neonatal
deaths occur during this time.”
“Since 1941 there has been, in various cities
in the United States, a definite, alarming in-
crease in both maternal and infant death rates.
These increases have been found to be due to
a decreased number of civilian physicians,
crowded hospital conditions, increased travel
486
November, 1945
Interpreting Medical Literature
■■■■'■ •• * -n •Y£:- * * 1 2 3 4 5 6
by the expectant mother, and inadequate help
in the home.”
“With the employment of the routine Wass-
mann reaction on all pregnhnf women, syphilis
has almost disappeared as a cause of prema-
turity. It is most striking to see how few in-
fant deaths are attributable to syphilis in the
annual report of the large obstetric clinics.
The medical profession has been taught . . .
that hypothyroidism frequently is the cause
of premature delivery and how it can be cor-
rected by keeping the basal metabolic rate
within normal limits. No doubt general hy-
gienic measures play a definite part in the
continuation of pregnancy to viability of the
fetus. Frequent hemoglobin determinations will
aid in recognizing anemia and Rh determina-
tions may be employed routinely in the near
future.”
“Intrapartum Care. One should attempt to
determine the size of the baby at the onset
of every labor and, if the child seems to be
less than 5i pounds in weight, no opiates
should be given in order to stop uterine con-
tractions. It is much wiser to rely on small
doses of barbiturates or preferably avoid any
analgesics, acquainting the patient with the
reason for not attempting to alleviate her
pains of labor. The administering of vitamin
K to the mother during labor is beneficial to
the premature infant by correcting any lack of
prothrombin. Inhalation anesthesia should be
avoided in the majority of the cases of pre-
maturity and the use of local infiltration, such
as pudendal block, offers the premature infant
its best chance of survival. Episiotomy is fre-
quently a wise measure to prevent any harm
to the small head of the infant. Spontaneous
delivery offers less trauma than any operative
interference . . . No doubt in the severe cases
of preeclampsia when the cervix is not suit-
able for induction of labor cesarean section
under local, caudal or spinal anesthesia will
save more uninjured premature babies than
the method now employed of induction of la-
bor with delivery through the natural pas-
sages.
“Postnatal Care. As soon as the premature
baby is delivered it should be kept warm, by
placing it in an already prepared incubator
with available oxygen. The trachea should be
carefully and thoroughly cleansed of any mu-
cus. The umbilical cord should not be clamped
until it has quit pulsating so as to obtain as
much blood as possible. Nurses especially
trained in the care of premature infants should
be constantly in attendance.” It - is generally
recognized that the premature infant often
develops serious anemia by the third of fourth
month of life. The <|bgtetrician should aid the
pediatrician in preventing the development of
the serious state of this condition.”
COMMENT
We would have no argument with this dis-
tinguished physician about the main points
in his discussion , however, we are inclined to
impress the fact that premature babies should,
if possible, be in the hands of a recognized
pediatrician as early as possible after birth.
Premature infants should not be handled by
a family physician or obstetrician any longer
than time will permit to get the premature in-
fant in care of a recognized pediatrician. We
are firmly convinced that a periatrician is just
as essential in the case of prematurity as a
surgeon of recognized ability in acute surgical
abdomen or as an orthopedist in a complicat-
ed bone fracture.
H. F. G.
INFORMATION WANTED!
The Directory Department and the Bureau
of Information of the American Medical As-
sociation are very anxious to obtain the names
and present addressses of all physicians who
have been released from the armed forces and
also the date that their military service termin-
ated.
These name® will be listed in the Journal
A. M. A. and in the Directory Report 'Service.
Many inquiries are being received daily from
physicians who are trying to locate either
former colleagues or medical officers whom
they, contacted while in military service.
If you know of any physicians who have re-
cently been released from the armed forces,
please urge them to send the following in-
formation to the Directory Department, Ameri-
can Medical Association, Chicago, 10, Illinois:
1. Full name
2. Date military service began and terminat-
ed.
3. Present address (residence and office)
4. Indicate whether in practice, retired, or
not in practice (on terminal leave, etc.)
5. If serving a residency in a hospital, in-
dicate period it is to cover.
6. Former permanent address (if different
from item 3.)
State Board of Hea\th
Felix J- Underwood, M-.D.
BRIDGING THE GAP
by
Eleanor Hassell, B.A., M.P.H.
Assistant Director, Health Education
The physician today is more interested than
ever before in the health education of his
patients. He is awake to the importance of
prevention of disease as well as the promotion
of physical fitness. Needless to say, he finds
it helpful for the patient to have an intelligent
appreciation of some of the fundamentals of
health and disease.
A great deal more is known about health
than is done about it. Medical science has
the answer to many health problems which
still plague the people of the state. Part of
the answer to the lag between scientific know-
ledge and healthy people is health education.
What is health education? This is a 64 dol-
lar question. Health education is a lot of
little things. Health education is also a lot of
big things. One sees its results in the bright
eyes and sparkling teeth of children. It is
seen again in clean, well-ventilated school-
rooms; in youngsters washing their hands be-
fore lunch, drinking milk and eating oranges,
playing games in the sunshine and , fresh air
in a spirit of fairness and sportsmanship, get-
ting enough sleep and rest, and in observing
the rules of good personal hygiene.
In communities, it is safe water supplies
and sewage disposal. It is clean, safe food-
handling establishments ; it is immunization
against preventable diseases; it is draining
swamps and screening homes; it is medical
examination and advice for needy expectant
mothers, children, and others. In other words,
health education is healthful action.
Health education is not new. It is as old
as man. Moses enacted the first sanitary code.
Physicians have been doing health education
for years. Health workers, dentists, nurses,
teachers practice health education every day
they work. But we still have many needs and
problems for health education to meet; so
many that in recent years a great organized
effort has been gathering momentum for a
more intensive attack ' on health problems
through education. .
What are some of these problems? The so-
called third of the population that is ill-fed
is only a starter. Nutrition is basic to good
health; malnutrition and deficiency states sap
vitality and often lead to serious disease. Such
borderline signs of malnutrition as night
blindness, nervousness, and spongy gums are
relatively widespread. The fortunate individual
whose symptms are recognized early can us-
ually be restored to health by a correction of
dietary habits. It is considered by outstand-
ing nutrition authorities that man is to a mark-
ed degree what he eats. Those who have
made studies of families over a period of years
find that their physical, social, economic, and
mental stature are greatly affected by the food
they consume. Less scientific but nevertheless
significant experiments in nutrition have been
conducted through school lunchroom projects.
Instead of a scant lunch or none at all, chil-
dren have received a nourishing meal in the
middle of the day. Results have been gratify-
ing. Children are healthier, minds are keen-
er, grades are better and disciplinary troubles
are markedly reduced.
Another widespread problem in some sections
of the state is hookworm disease. Hookworm
infection affects as many as 70 per cent of the
children in some of the areas of south Missis-
sippi. Tooth decay with gum boils, abscesses
and bleeding gums lowers the vitality of thous-
ands of school-age children. Such preventable
diseases as diphtheria and whooping cough are
still prevalent. Then there is tuberculosis, an
outstanding example of a disease in which
education is. so imperative. With no specific
drug to cure it, educational measures must
be directed toward early medical and perhaps
surgical attention, proper diet, rest, fresh air,
and good hygiene. Close cooperation of the
patient with his physician is stressed, and he
is encouraged to conform to whatever new
mode of living the physician may devise for
his early recovery.
Another health problem is malaria, which
is being attacked both by elimination of mos-
quito-breeding areas and by education. Much
has been accomplished in reducing the inci-
dence of this disease in the state but there
487
488
State Board of Hcaltn
November, 1945*
are still several hundred who suffer its ravag-
ing chills and fever every year.
Malnutrition, dental decay, tuberculosis,
hookworm disease, malaria — these are some of
Mississippi’s more obvious and immediate
health problems. It is within the province of
health education to create in people an aware-
ness of these and other health problems, to
give them sound information as to What they
can do to help toward their solution, and to
stimulate and encourage constructive action.
Mississippi is a fortunate state in that educa-
tion and health departments have joined hands
in a combined educational attack against for-
ces which jeopardize good health. Teachers
are learning through workshops how to teach
the fundamentals of healthful living and dis-
ease prevention. In addition to the central
state staff, four county health educators have
been at work and they will soon be joined by
eight trainees now studying at two of the
country’s outstanding schools of public health.
So important is this health education program
that friends outside the state, notably the
general education board of the Rockefeller
Foundation, have made possible fellowships
for a limited number of properly qualified peo-
ple to train in this field of work.
A professional health educator has many
and varied duties. Given an area in which to
work, she first surveys the community to de-
termine what its particular health problems
are. She then assists others in surveying and
finding out the health problems in their own
fields of interest. For instance, she helps the
teacher survey her classroom to find out if
the lighting, seating, heating, and ventilation
are satisfactory. The interested teacher will
want to make certain about such questions as
these: Is plenty of safe drinking water avail-
able? Is there opportunity for the children to
wash their hands? How many of the children
sleep sufficiently long hours every night? How
many give evidence of good sight; of good
hearing? How many have three nourishing,
wholesome meals each day? Am I a healthy,
happy teacher? Do I avoid the use of fear and
intimidation in my relations with the children
in my care? These are but a few searching
questions which the teacher may ask herself
in regard to health in her classroom.
The term “survey” has been so often used
and abused that many have come to regard it
almost with apathy. If, however, people who
need the information can be helped to make
their own health surveys, a real awareness
of their strong points and weak points results.
Another thing which the health educators -
do is to assist in stimulating health interest
and awareness among such groups as already
have health activities — voluntary health agen-
cies, women’s clubs, agricultural groups, civic
organizations and service clubs. Almost al-
ways these groups are already interested.
Often they need only encouragement and oc-
casional help to achieve good results.
In some parts of a county where no organi-
zation exists with which the health educator
can work, she organizes special health study
groups or committees. Another of her jobs
is to assist professional, voluntary and lay
organization leaders and committee members
to plan and conduct forums, institutes, and
other forms of study and action programs on
health and related problems. She also helps
in planning in-service training programs for
teachers and others, in pre-service training, in
consultation and guidance for adult groups,
and in widespread use of educational pamph-
lets, newspaper releases and the radio.
One county health educator, working in the
Delta area, reported on one recent month’s;
work as follows :
The American Legion series in parent-
hood education has been started in four
communities. Schedules have been set up
for the next three months to complete the
course in each community.
The Parent-Teacher Association in one
town is giving fifteen minutes of each
monthly meeting to health. The health
educator attended all major venereal dis-
ease clinics during the month, gave talks,
showed movies. Nine community health
clubs for Negroes have been organized in
the communities where the vocational
schools are located. The health educator-
holds two or three night meetings each
week which makes possible a monthly
meeting in each of these communities.
Once a month the Negro county council
meets with leaders of the county and rep-
resentatives from each of these clubs.
These organizations provide a channel for
the adult Negro health education program.
The Negro schools in the county have all
been open during August. Teachers were
reached by working with primary, upper
elementary, and high school groups at two
monthly meetings of the county teachers’
association. Separate group planning was
done with committees from each of these
November, 1945
State Board of Health
489
groups in the health educator’s office.
Eleven charts and graphs on the incidence
of sickness, death, and other vital statis-
tics were prepared for the annual report.
Two original radio programs and six news-
paper stories were prepared by the health
educator.
This report reflects but a few of the activi-
ties of a local health educator for one month.
Programs vary from month to month as the
need in the county varies. Always the educa-
tional program is tied into the service pro-
gram rendered by the health officers and
other staff members. People who are getting
immune serum for measles, chest x-rays, or
having DDT sprayed in and near their homes
are naturally interested in these subjects and
are glad to learn more about measles, tuber-
culosis, or malaria. Therefore the health edu-
cator makes a special effort to see that in-
formation is imparted when interest is high.
Constant evaluation goes on in the health
educator’s planning and direction of her ef-
forts. If what she does influences favorable
action on the part of individuals, school and
communities, then the plan is working. If
not, another plan or another approach is tried.
Specific cures are available to eliminate
hookworm disease, syphilis, and other dis-
ease enemies in Mississippi. Preventive meas-
ures such as immunization, sanitation and
isolation are possible which could reduce to
a fraction the annual toll of many communi-
cable diseases. The newer knowledge of nutri-
tion plus other measures of personal hygiene
and a more general application of today’s
scientific knowledge could build a much
stronger, more physically fit race of
men, capable of assuming the full responsibil-
ities of citizenship in a period when so much
strength and wisdom are needed.
The difference between what is known and
what is done is the province of health educa-
tion. It is a field of unlimited opportunities
for human betterment.
FEAR, IGNORANCE, AND DELAY —
Representatives of twelve Southern states
attended the Fourth Training School, Region
Three, Field Army, the American Cancer
Society in Durham, North Carolina, on Octo-
ber 22, 23, and 24, 1945.
“Fear, ignorance, and delay, three great
allies of cancer can only be eradicated
through education,” said Mr. J. Louis Neff,
executive director of the American Cancer
Society, in addressing the regional conference.
He also said, “Education is a mental vacci-
nation. It vaccinates the mind to prepare the
individual for the day when cancer becomes
a personal problem. Education must be a
continuous process and universal in its scope
so that the public will face the facts sanely
and calmly and accept the chances of cure.
Along with education we must provide for
examination centers, improved diagnostic and
treatment services and greatly enlarge the
research program.”
Talks made were “A Preview of a New
Era” by Dr. Edwin P. Lebman, vice-president
of the American Cancer Society, “Plans and
Programs of the American Cancer Society,”
Mr. J. Louis Neff, “Training Workers in
Health Education,” Dr. Lucy Morgan, pro-
fessor of public health, Chapel Hill, North
Carolina.
The educational program of the American
Cancer Society was discussed at Chapel Hill
in the School of Public Health. Participating
in this program were: Mr. J. Louis Neff,
the American Cancer Society, Dr. J. M.
Rosenau, dean of the School of Public Health,
University of North Carolina, and Dr. Lucy
Morgan, professor of public health. Mrs. Har-
old V. Milligan, national commander, the
Field Army of the American Cancer Society,
Doctor Rosenau, Dr. Alton Ochsner, medical
director of the Field Army, Region Three,
of Ochsner Clinic and professor of Tulane
University, New Orleans, and Miss Eleanor
Hassell, assistant director of health educa-
tion, Mississippi State Board of Health, par-
ticipated in the discussion. Students in the
School of Public Health and a health edu-
cator told of health education activities and
discussed the function of a health educator.
Duke University Hospital was used for
scientific talks. Topics and speakers were:
“Carcinoma of the Breast” — Dr. Deryl
Hart, Duke University.
“Malignancy in the Urinary Tract” — Dr. E.
P. Alyea and Staff, Duke University.
“X-ray Therapy in Malignancy” — Dr. Rob-
ert Reeves and Staff, Duke University.
“Bronchiogenic Neoplasms” — Dr. Alton
Ochsner, Tulane University.
“Malignancy in Bone” — Dr. R. A. Moore.
Bowman Gray School of Medicine.
“Malignancy of the Thyroid” — Dr. Roy Mc-
Knight, Charlotte, N. C.
“Carcinoma of the Uterus”— Dr. Bayard
Carter, Duke University.
490
VComan’s Auxiliary
November, 1945
~ “Chorio-epithelioma” — Dr. Ivan Procter,
North Carolina.
“X-ray in Malignancy of the Uterus” — Dr.
H. B. Ivey, Goldsboro, North Carolina.
Sessions on publicity, campaign techniques,
and financing the programs were held. The
1945 campaign awards for funds raised were
presented to Louisiana and Oklahoma. Cam-
paign plans for 1946 and materials to be used
were discussed.
Subjects discussed in panels were: Organiz-
ing the State Division, Organizing the Field
Army, the History of the Field Army, Coop-
erative Effort in Cancer Control, Financial
Policies, and Refresher Courses.
NEWS ITEM
The Mississippi Public Health Association
will meet in annual session in Jackson, Decem-
ber 10-12, according to an announcement from
Dr. H. B. Cottrell, secretary. An excellent
program is being planned which it is hoped will
prove helpful and stimulating to members and
guests alike.
Womans Auxiliary
President Mrs. L. J. Clark
Vicksburg
President-Elect Mrs. Stanley Hill'
Dr. Felix J. Underwood, executive officer
of the Mississippi State Board of Health and
chairman of the state executive committee of
the American Cancer Society, participated in
discussions and presided over the session for
the discussion of cooperative effort in cancer
control. " Others on the program were : Mrs.
J. I. Wates, state commander, Mississippi Di-
vision, the American Cancer Society, Dr. Em-
ma Gray, regional chairman of the service
program, the American Cancer Society, and
Miss Eleanor Hassell, assistant director of
Health Education, Mississippi State Board of
Health.
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Plonry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording Secretary Mrs. Geo. W. Owens
. Jackson
Fourth Vice-President Mrs. Ben Walker
Jaf kson . .
Treasurer Mrs. J. D. Simmons
, ‘ Cleveland
Historian Mrs. Harvey Garrison
' !C 'V Jackson
The annual meeting of the American Can-
,cer Society will be held at the Edgewater
Gulf Hotel, Edgewater Park, Mississippi, in
the fall of 1946. Mississippi will welcome
representatives from all of the states and *
national regional officers to this first national %
fleeting of the American Cancer Society to
be held in the South! V"‘v"
CHRISTMAS
r
There is no time during the year when our
hearts should be more grateful and the spirit
of good fellowship more evident than at Chris-
rkas time. This year, our first Christmas since
the war’s end, should be a joyous one for once
more the song of long ago rings out to pro-
claim to the world “Peace on earth, good
will to men”.
PREVALENCE OF COMMUNICABLE
DISEASES IN MISSISSIPPI"
Sept.
Sept- Sept-
5-Yr.
Acute Poliomyelitis
13
34
16.6
Bacillary Dysentery
925
1011
845.8
Dengue
10
2
2.2
Diphtheria
94
79
60-6
Influenza
1880
2069
1820.4
Measles
85
119
166.0
Meningococcus meningitis
5
9
5.0
Other Forms Meningitis
3
5
2-6
Pellagra
170
248
252.2
Pneumonia
573
566
487.2
Pulmonary Tuberculosis
137
229
138.2
Scarlet Fever
40
44
42.6
Smallpox
0
0
.0
Tularema
4
4
2.2
Typhoid Fever
18
25 i
23.0
Typhus Fever "
37
17
19-2
Undulant Fever
21
6
7.2
Whooping Cough
379
898
653.0
The happy Christmases of the past will this
year be revived. Christmas carols, Christmas
trees, holly wreaths, family gatherings were
cherished memories of our boys in the armed
service thousands of miles from home. As
these cherished American traditions again be-
come part of their lives this joyous season as
families are reunited, let us observe this
Christmas with prayers of thankfulness and
gratitude for our many blessings.
Where there is peace and good will there
is love, affection, and kindness. Wars cannot
erase the many good qualities of man. Christ-
mas as well as throughout the year we should
practice respect and consideration for others.
Happiness for ourselves and others ultimately
comes through service mankind.
November, 1945
There is no better place and no better time
to cultivate the spirit of good fellowship than
in our own Woman’s Auxiliary at this holi-
day season. The war-torn world needs the
kind and friendly spirit that we can practice
in our group of doctors’ wives.
We must again turn to the same Star, lis-
ten to the same Song and bow again at the
feet of the Babe of Bethlehem that we seem
to forget.
In each home may there be happiness, cheer,
and comfort for those in sorrow . . . con-
sideration for all. It is Christmas. It is a time
for good will. It is peace.
With affection,
(Mrs. L. J.) Anne J. Clark
President
CLARKSDALE AND SIX COUNTIES
AUXILIARY
The Clarksdale and Six Counties Auxiliary
met in Clarksdale on November 7, 1945, for
the regular fall meeting. Preceding the busi-
ness a delightful tea hour was enjoyed with
the nurses of the Coahoma County Health
Department as guests.
The following officers were elected for the
ensuing year: president — Mrs. T. G. Hughes,
Clarksdale ; vice-president — Mrs. Arthur
Smith, Sumner; secretary-treasurer — Mrs. D.
H. Raney, Mattson; and program chairman —
Mrs. J. L. Levy, Clarksdale.
In the absence of the president, Mrs. T. G.
Hughes, who was ill, Mrs. J. L. Levy presided.
The speaker of the afternoon was Miss Cassie
Smith, who chose as her subject, “The Activi-
ties of the Doctor’s Wife in Connection with
the State Welfare Program.”
The meeting adjourned and the doctors’
wives joined their husbands at the Alcazar Ho-
tel for the banquet. Dr. Charlie Mitchell, Whit-
field, Miss., was the after dinner speaker.
IN MEMORIAM
(Tribute by Mrs. Harvey F. Garrison, Sr.)
Since the close of our Auxiliary meetings of
the past year another faithful member has
passed to life eternal — Lillie Mckee Van
Alstine, wife of the late Dr. Frank L. Van
Alstine, outstanding urologist of Jackson, Mis-
sissippi, entered into the heavenly portals
.on August 12, 1945. I had many personal
491
and intimate contacts with her and deem it a
. .
privilege to try to pay her a just and loving
tribute, for to know her was not only to love
her but to praise her.
She stood for certain sterling qualities of
mind and spirit that have a value and a signif-
icance, impersonal and enduring. *
Her work as state president of the Woman’s
Auxiliary in 1933 was outstanding and while
we shall miss her friendly face and the wis-
dom of her counsel, we shall not feel that she
is entirely separated from us, for her contri-
butions and enthusiasm for Auxiliary work
has given her an imperishable share in its
achievements. Her work, well done, is worthy
of emulation by us and could inspire us to
carry on beneath a banner raised high in
loyalty and devotion to our purpose.
She had not reached the sunset of life, but
in the noontide answered the call, Come unto
me all ye that labor and are heavy laden and
I will give you rest.
Lillie was an ardent and faithful worker in
her home, her community, and her church, a
devoted and helpful wife, an affectionate and
attentive daughter, an efficient and loyal club
and church worker.
We remember Christ promised us in John
14, In my Father’s house there are many man-
sions— 7 go to prepare a place for you.
“Long, long may my heart with sweet
memories be filled,
Like the vase in which roses have once
been distilled
You may break, you may shatter the vase
if you will,
But the scent of the roses will cling ’round
it still.”
She is gone and the vase of her life is
shattered but the scent of the roses brings
’round her memories still.
NORTHEAST MISSISSIPPI THIRTEEN
COUNTIES AUXILIARY
The last quarterly meeting of the North-
east Mississippi Thirteen Counties Auxiliary
will meet December 11 at the home of Mrs.
R. D. Kirk in Tupelo at two o’clock. Ail
members are urged to be present for this
Christmas meeting.
*****
Poise is that quality which enables you to
try on a pair of shoes without seeming to
be aware of the hole in your sock.
— Gelett Burgess
The Mississippi Doctor
November, 1945
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1
The Endocrine Aspects of Hypertension
James H. Hutton, M. D.
Chicago, Illinois
Hypertension, now one of the leading
causes of death, merits study from every
angle that promises to throw light on its
etiology or treatment. Its endocrine aspect
is probably neglected more than any other
phase. The following remarks are intended
only to call attention to the fact that some
cases — probably a small percentage — seem to
be based on endocrine disorders and to be
more satisfactorily managed when approach-
ed from that standpoint.
There is considerable evidence that endocrine
, disorders may sometimes constitute
the only, or the principal, etiologic factor.
Endocrine preparations may be used with con-
siderable relief in some cases and in others
certain of the endocrine glands may be at-
tacked directly by surgery, radium or x-ray
with the idea of changing their functional
and anatomic statue, with resultant or coin-
cident relief of symptoms and reduction of
blood pressure.
Endocrinologists seem inclined to take a too
restricted view of endocrine disorders. They
center their study on the functional status
of a single gland or a single tissue affected
by one hormone of the gland under scrutiny.
In so doing they may overlook the fact that
syndromes ordinarily thought to be far re-
moved from the endocrine system may have
an endocrine component, or the patient a con-
comitant endocrinopathy. Treatment of the
latter sometimes has a surprisingly good ef-
fect on the primary syndrome.
Etiologic Factors. Hypertension has been
found in association with the following en-
docrinopathies : hyperthyroidism, hypothyroid-
ism, cancer of the thymus, some tumors of
the adrenals involving either the medulla or
the cortex, certain ovarian tumors and some
malignant tumors of the testes. Evidence sug-
gests that the eosinophilic cells of the anterior
lobe of the pituitary secrete a substance whicn
influences kidney function. An increased se-
cretion of the basophiles of the anterior lobe
pregnancy has been demonstrated. 2 Hofbauer*
of the pituitary during the last trimester of
says there is ample proof for the view that
the toxemia of pregnancy is the result of an
undue activity of the posterior pituitary. Grif-
fith* reports the production of permanent
hypertension in rats by the repeated intraperi-
toneal injection of small doses of pitressin.
Liemdorfer5 observed the same effect after
the intrathecal injection of posterior pituitary
extract. All forms of hyperpituitarism-gigant-
ism, basophilism and acromegaly — have been
found in association with hypertension or dia-
betes or both. The number of acromegalics
affected with diabetes is estimated from 40
per cent downward. On the other hand, Sim-
monds’ disease and less severe forms of pitui-
tary deficiency are accompanied by a tendency
to lower blood pressure and an increased tol-
erance for glucose. Addison’s disease is char-
acterized in most cases by hypotension and
a tendency to hypoglycemia.
MacKay and Sherrill6 report a direct re-
lationship between the functional activity of
the kidneys and the level of thyroid function.
It has been reported" that testosterone ad-
ministered to rats was followed by enlarge-
ment of the kidneys and hypertrophy of the
tubular epithelium. Such kidneys were said to
be more resistant to nephrotoxic agents. The
administration of desoxycorticosterone ace-
tate is said to cause an increase in the weight
of the kidneys and the size of the renal
tubules.8
Selye and Hall9 reported that cardiac hy-
pertrophy and nephrosclerosis were readily
produced in rats by overdosage with desoxy-
corticosterone acetate and sodium chloride.
They suggested that adrenal cortical hyper-
activity be considered as a possible etiologic
factor in renal hypertension in man.
Diabetes has been noted in most of the en-
docrine disorders associated with hypertension
except hypothyroidism.
The many resemblances between hyperten-
sion and diabetes suggest a least common
denominator in their etiology and the avail-
able evidence points to the pituitary and ad-
renals as the most likely offenders.
Treatment. A rise in the systolic without
a corresponding increase or even with some
decrease in the diastolic pressure is a common
occurence in Graves’ disease. Hyperthyroid-
ism associated with adenoma is often accom-
panied by hypertension and cardiovascular-
renal disease. Correction of the hyperthyroid-
ism in such cases is followed by reduction in
494
Hypertension — Hutton
hypertension if the process has not gone too
far. Bisgard1*) reports that 50 per cent of
his series experienced a reduction in both sys-
tolic and diastolic pressure following thyroid-
ectomy.
One sees an occasional case of hypertension
with hypothyroidism in which the administra-
tion of an adequate dose of thyroid is accom-
panied by marked reduction of the blood pres-
sure.
The onset of hypertension often occurs at
the menopause. Schaefer 11 reported satis-
factory reduction of blood pressure following
the administration of estrogens in thirteen
menopausal women. Other writers 12, 13 have
reported similar experiences. The administra-
tion of some of the synthetic estrogens is re-
ported to have been followed by con-
siderable reduction in blood pressure.14. My
own experience in the treatment of hyperten-
sion with the estrogens has not been satis-
factory. I have seldom seen any noteworthy
reduction in blood pressure accompany this
type of therapy.
Testosterone is reported15 as having a bene-
ficial effect in some cases of hypertension. I
have treated a few cases in this way with
favorable results. This substance has also
been reported 16 as relieving some cases of
angina. The optimum dose seems to be 25
mg. twice weekly for eight weeks. As symp-
toms improve the frequency of injections
should be reduced to the number necessary to
keep the patient comfortable. A better method
of administering this substance is by implanta-
tion of pellets subcutaneously. Three or more
75 mg. pellets may be implanted each time
and repeated as indicated by the recurrence of
symptoms. Unfortunately these pellets can-
not always be obtained.
Where hyperfunctioning glands can be rec-
ognized they should be removed in whole or
in part by the surgeon or reduced to more
nearly normal levels of function by the
roentgenologists. Unfortunately tumors of the
adrenal cortex too small to be recognized
preoperatively may be sufficiently active to
cause hypertension or diabetes. Hyperfunc-
tioning adenomas of the anterior pituitary may
also be so small as to escape detection by
our present diagnostic methods. Where the
diagnosis can be reasonably substantiated, the
roentgenologist may give considerable relief.
Griffith et al4 report that the antidiuretic
December, 1945
substance of the posterior lobe disappeared
from the serum of a hypertensive for six
months following irradiation of the pituitary.
The blood pressure fell from 230 to 130. Three
weeks after the antidiuretic substance reap-
peared the blood pressure rose to 190. After
further irradiation it disappeared and the
blood pressure fell to 128. Papilledema dis-
appeared in two of their cases following ir-
radiation.
Some obese patients with hypertension ex-
hibit the signs and symptoms of combined
pituitary and thyroid deficiency. Some of
these respond very well to a reduced caloric
intake plus the administration of desiccated
thyroid and pituitary extracts. The correct
dose of thyroid can be determined only by
testing the patient’s response to gradually in-
creased doses. Begin with one grain per
day. In one week if there are no signs of
hyperthyroidism add one-half grain per day
and continue for another week. At that time
the dose may be increased another half grain.
The dose may be accurately determined by
clinical observation without determining the
B. M. R. Signs of overdosage are tachy-
cardia, tremor of the tongue or outstretched
fingers, nervousness, insomnia or a slight rise
in temperature. When any of these occur re-
duce the dose of thyroid by 25 per cent and
continue at that level.
Before giving a course of injections of
pituitary extracts the blood pressure and
blood sugar response to them should be check-
ed. Take the blood pressure before and
after the injection of 0.5 cc. anterior pituitary
extract and on another day repeat the pro-
cedure using 5 units of posterior lobe extract.
The blood sugar (it should not, or at least
need not be fasting) should be taken before
and one hour after these injections. The
blood pressure should be taken every 15
minutes for an hour and a half
after the injections. If there is a significant
rise in blood pressure or blood sugar follow-
ing these injections, they should not be used
in treatment. On the other hand, if the blood
pressure falls markedly, it is more than like-
ly that an injection of these substances given
twice weekly for two months and then once
a week for ninety days will have a markedly
beneficial effect on the blood pressure and
symptoms. Cases in which this type of ther-
apy is helpful are not, so far as my experi-
ence goes, numerous.
December, 1945
Hypertension — Hutton
495
Two measures for the relief of hypertension
have received general acceptance within the
past decade: first, surgical interference with
the sympathetic and, second, kidney extracts.
The various surgical procedures presumably
owe part of their good effects to a change
in the level of adrenal function and, through
the influence of these glands, also of pituitary
function. Boyer *7 says that patients showing
the best results from surgical procedures are
the ones who often do well on medical manage-
ment, namely those with early, mild hyperten-
sion, and says that the percentage of reported
success is not significantly greater with sur-
gical than with medical management.
For more than ten years we have treated
some carefully selected cases of hypertension
by low-dosage irradiation of the pituitary and
adrenal regions. Four hundred and three cases
have been, treated in this way. Out of 317
cases that we thought had adequate treat-
ment, 221 or 69.8 per cent are said to have
improved.
Symptomatic relief is much more striking
than the effect on blood pressure and occurs
manv times when the blood pressure is but
little affected. Headache, vertigo, nervous
tension, heart consciousness and precordial
pain are the symptoms most often relieved.
The most favorable results have followed
the use of the- following factors: 120 kilo-
volts, 2 mm. aluminum filter, 50 cm. skin
target distance, 3 milliamperes, 50 r to each
area treated. Each side of the pituitary is
treated through a portal 10x10 cm. and the
adrenals through a common portal 15x15 cm.
The three areas should be treated on the
same dav. Treatments may be repeated at
weekly intervals until six are given. If a
significant fall in blood pressure or relief of
Symptoms follows the first or any other
treatment, no more are given until there is a
rise in blood pressure or a recurrence of symp-
toms. Hence one or two treatments may be
sufficient for several weeks or months.
Confirming our own observation that only
small doses of irradiation are effective in re-
ducing blood pressure, others! 8 using larger
doses have reported failure to achieve worth-
while results. The doses were approximately
ten times as heavy as those we found effective.
We had discovered long before these reports
that such large doses fail to produce signifi-
cant symptomatic relief or reduction in blood
pressure. It should be remembered that small
doses or roentgen rays are effective in the
treatment of certain infections while heavier
doses do no good.
At various times over the past thirty years
men have irradiated the adrenals in the hope
of favorably influencing hypertension. Worth-
while results have seldom followed such pro-
cedures. Raab,!9 using much larger doses ap-
plied to the adrenal region, noted no effect on
blood pressure though he reported ability by
this procedure to relieve angina pectoris. It
appears that including the pituitary in these
treatments and using very small doses of the
rays makes them more effective.
Considering our incomplete knowledge of
hypertension it may be set down as an undis-
puted truth that no victim of hypertension
has been completely studied until his endocrine
status has been determined.
BIBLIOGRAPHY
1. Barnett, H. L.; Perley, A- M- ; and Heinbecker,
F. : Influence of Eosinophilic Cells of Hypophysis on
Kidney Function, Proc. Soc- Exper. Biol, and Med-
52:114-116, Febreary, 1943-
2. Severinghaus, A. E. Cellular Changes in Anterior
Hypophysis with Special Reference to Its Secretory
Activities: Physiol. Rev. 17:566-588, October, 1937.
3. Hofbauer, J. : Endocrine Factors in the Mechan-
ism of Toxemia of Pregnancy, Am. J- Surgery New
Series LXV pages 361-363 September, 1944.
4- Griffith, J. Q. Jr-: Corbit, H. O’Brien; Ruther-
ford, R- B.; and Lindauer, M- A.: Studies on Criteria
for Classification of Arterial Hypertension V. Types
of Hypertension Associated with the Presence of
Posterior Pituitary Substance. Am- Heart Journal
21: 77-79 January. 1941.
5. Leimdorfer, A. Ueber die Wirkung intralumbal
eningefuhrter Hypophysenpraparate auf den Baut-
druck, Arch. f. exper. Path. u. Pharmakol- 118:
253-258, 1926.
6. MacKay, Eaton M- and Sherrill, James W. :
Influence of Thyroid Activity upon Renal Function,
J. Clin. Endocrinology 3: 462-465, August, 1943.
7. Editorial: Relation of Androgens to Kidney
Function, J- Clin. Endocrinology 3: 111, February,
1943.
8. Anderson, John A. Desoxycorticosterone Ace-
tate and Water Exchange, J. Clin. Endocrinology 3 :
615, November, 1943.
9. Selye, Hans and Hall, C. E. : Production of
Nephrosclerosis and Cardiac Hypertrophy in the Rat
by Desoxycorticosterone Acetate Overdosage, Am.
Heart Journal 27 : 338-343, March. 1944.
10- Bisgard, J. Dewey: The Relation of Hyperthy-
roidism to Hypertension, Ann- of Surg. 115: 42-46.
January, 1942.
11. Schaefer, Robert L. : Menopausal Hyperten-
sion, Endocrinology 1: 705-709, November -December,.
1935.
12- Queries and Minor Notes: J. A. M. A. 112:-
354, January 28, 1939-
13. Walker. T. C. : Use of Testosterone Propionate
and Estrogenic Substance in Treatment of Essential
Hypertension, Angina Pectoris and Peripheral Vascu-
lar Disease. J. Clin. Endocrinology 2: 560-568, Sep-
tember, 1942.
14. Hufford, Alvin Ray: The Synthetic Estrogen-
Carcinoma of Gingiva — Stacy
December, 1945*
496
if
y'Qfctofollin (in oil) Report of Clinical Investagation,
A. M. A. 123: 259-260, October 2, .1943.
£ 15- Sex Hormones and Hypertension, Section can-
ned “Annotations” Lancet 2: 901-902, April 16, 1938.
v 16. Waldman, Samuel: The Treatment of Angina
Pectoris with Testosterone Propionate, J. Clin. En-
docrinology 5 305-317, September, 1945.
17. Boyer, Norman H : The Treatment of Hyper-
tension, Med- Clin- North America 26: 1421-1437,
,AP&' . ■ r.
i <&. iv
1
September, 1942.
18. Baird, Perry C-; Lingley, J. R., and Palmer,
Robert Sterling: The Failure of Roentgen Ray Ther-
apy of Pituitary and Adrenals in Essential Hyperten-
sion, New England J. Med 211: 952-953, November
22, 1934.
19. Rabb, W- : Roentgen Treatment of the Adrenal.
Glands in Angina Petoris (One Hundred Cases) Ann
Int. Med. 14: 688-710, October, 1940-
Epiclemoid Carcinoma of the Lower Gingiva
A. J. STACY, Jr., M. D.
Tupelo, Miss.
• dd ‘ a
The title of this paper has been so chosen
in order that the overwhelming confusion
associated throughout the literature might
not further be embarrassed with an additional
burden as concerns intra-oral carcinoma. This
particular subject has apparently been the
most neglected of all carcinomata, and in the
language of an interne, it might be considered
as the parasite of intra-oral carcinoma. It has
been reported under various titles as cancer
of the jaw, alveolus, alveolar border, alveolar
process, or mandible; all of which are incorrect
from an anatomical standpoint. Gums, or
gingivae, is the only term which defines the
soft tissues covering the alveolar processes of
the maxillae or mandible, and so, gingiva
has been adopted.1
The present report is based upon an un-
selected and consecutive group of twelve
cases, including all comers to Ellis Fischel
State Cancer Hospital, who have proved pri-
mary carcinoma of the lower gingiva by bi-
opsy.
ANATOMY OF THE LYMPHATICS
(a) External or vestibular surface — The ex-
ternal gingival lymphatic network forms a
plexus in the lower gingivo-buccal gutter,
which anastomoses across the midline an-
teriorly. In the gingivo-buccal gutter on each
side the vessels pass laterally into the cheek,
join the lymphatics of the cheek, and pierce
the buccinator muscle to drain into the pre-
vascular node, and in most cases, into the
preglandular and retrovascular nodes as well,
(b) Internal lingual Surface — The internal
*R.ejwI -before the Northeast Mississippi Thirteen
Counties Medical Society, Tupelo, December 11,1945.
vessels make up part of the lymphatic net-
work of the floor of the mouth and under
surfaces of the tongue; the larger vessels
pierce the myelohyoid and drain mainly into
the preglandular node of the submaxillary
group. Considerable drainage from this area,
especially from the posterior region, passes
directly to the subdigastric nodes of the in-
ternal jugular vein.
A small part of the lymph from the anterior
inner surface passes into the submental nodes
with the drainage from the adjoining floor
of the mouth.1
General Incidence — Johnson and Daniels9,
state that squamous cell carcinoma of the
lower gum constitutes almost one-half of ma-
lignant growths of the buccal mucosa. It is
reported by Martin1 that cancer of the gums
makes up about 10 per cent of all malignant
tumors of the mouth with cancer being more
common in the lower rather than the upper
gingiva (fifty-four cases as compared with
forty-six). Gaini6 reported a series of fifty-
three cases in which 68 per cent of the tumors
occurred in the lower jaw*
Age, color and' sex — The average age of
twelve patients in the present series was 67.1
years. The youngest patient was forty-eight
and the oldest patient eighty-three years old.
All of the patients were males, and all were
white with the exception of one colored pa-
tient. Kirkham4 has made the statement that
these tumors as well as all jaw tumors with
the exception of equlis, are more common in
the Negro race.
Position of Growth — In the present series
three lesions occurred in the region of the
third molar; two occupying an entire one side;
December, 1945
Carcinoma of Gingiva — Stacy
497
one in the region of the canines; one at the
angle of the mandible; and five with regions
not listed. Six of the lesions were located on
the right side, and six on the left side. The
size on admission varied from 1x0.5 cm. to
involvement of the entire one side. Thoma5
states that the third molar region between the
mandible and the cheek is a favorite location.
Causitive Factors- — As of all cancer, many
ideas and causes of cancer have been offered,
but nothing might be earmarked as truly re-
vealing. Some of the various contributory fac-
tors are infections around the teeth, retained
tooth roots, ill-fitting dentures, tobacco, and
syphilis. Quick6 raises the question concern-
ing the reaction of tissues to gold in which he
has found the adjacent membrane to be un-
duly indurated and leukoplakia common. John-
son? concluded that cancer of the lower jaw
rarely occurs in a clean mouth where the
normal alkaline reaction of the saliva is re-
tained. Bloodgoods states that the most com-
mon cause of cancer of the mucous membranes
of the gum is leukoplakia. In ninety of the
Wassermann tested cases of Martini, positive
reactions were obtained in only 3 per cent. In
the present series there occurred only one
positively tested Wassermann. Also in this
series there were three patients in whom a
previous recent extraction of teeth in the
affected area was reported. Kirkham4 states
that in practically all of his cases the teeth
had been extracted under the mistaken sup-
position that they were the offending mem-
bers.
Symptoms — In this series, the most common
first symptom was divided equally between
pain and a swelling mass, with the second
most common being pain. Martin4 reports 70
per cent of his patients with a first symptom
of “soreness.” Johnson and Daniel state, that
unlike malignant disease in other areas of the
body, pain may be a fairly early evidence of
the disease. The duration of symptoms varied
from two months to fifteen years with an
average duration of symptoms being 24.3
months. The average duration of symptoms
as reported by Martin4 was 6.2 months.
Clinical Course — “Carcinoma on the gingiva
mav form an ulcer with a raised, indurated
margin containing nodules which may be mul-
tiple. In other instances it develops to a larger
size and forms a bulky tumor that slowlv
forms a large undulating mass which, when
found in the mandible, pushes the tongue
aside. When occurring on the external sides
of the jaws it produces facial deformities.”5
“The lesion usually occurs first on the apex
or margin of the gums, which produces neither
pain nor other discomfort. When first dis-
covered by the patient it is likely to be con-
sidered a dental abscess. If a tooth is ex-
tracted, the growth may progress by way of
the tooth socket to invade the bone. In other
cases, as the tumor enlarges it may interfere
with the fit of a dental plate or removable
bridge and the patient mistaking the effect
for the cause, believe that the denture has
provoked the lesion. Unless the growth in-
vades the underlying bone through the tooth
socket following extraction, the periosteum
proves resistant for some time, and the tu-
mor spreads peripherally into the cheek or
floor of the mouth to form a broad, flat super-
ficial ulcer several centimeters in diameter. In
other cases, especially in tumors of lower
grade, the periosteum resists invasion and the
growdh fungates into the mouth. After a
period of several months the periosteum is
finally perforated, and then bone is rapidly
invaded and eroded with deep invasion of the
mandible, and pathologic fractures. A growth
in the lower gum may extend through the
bone to the skin over the anterior surface of
the mandible or submaxillary region. Such
deep invasion of bone is usually associated
with sepsis, both locally and in the submaxil-
lary nodes, so there is a combination of in-
flammatory hyperplasia, local cellulitis, and
metastatic invasion of the submaxillary, and up-
per cervical nodes. A combination of these
various disease processes makes it difficult to
determine the extent of the cancer.”4
Extension of the Growth — In the present
series there were eight cases in which bone
erosion was roentgenographically demonstra-
ble. There was one pathologic fracture of the
mandible; one case in which the disease had
spread to the floor of the mouth; one case
where there was ulceration of the skin over-
lying the mandible; and one case where there
was a leukoplakia on the buccal mucosa ad-
joining the lesion. It is stated by Martin1 that
when the growth has once invaded the medulla
of the mandible, it may then progress for
several centimeters before again appearing
on the surface.” Bloodgood8 has stated that
extension to the cheek gave a worse prognosis
than extension to the floor of the mouth.
£98
December, 1945
Carcinoma of Gingiva* — Stacy
Johnson and Daniel2 make plain that the
primary lesion is in close proximity to bone,
and invasion of the bone occurs very early.”
Metastasis — The main drainage is into the
submaxillary group (pre-glandular, pre- and
retro vascular) where nodes involved first in
about three cases, with only two cases occur-
ring first in the sub-digastric region. The pre-
and retrovascular lymph nodes lie very close
to the primary lesion in cancer of the pos-
terior lower gum, and in advanced cases the
two foci of the growth tend to coalesce, and
invade jointly the adjacent tissues. After in-
volvement of the first “echelon” the disease
disseminates to the middle and lower nodes
of the jugular chain and to the viscera. Bi-
lateral metastasis is practically nil.”1
Systemic Metastasis — Martin1 reports 35.7
percentage visceral involvement, and states
that visceral dissemination occurs more fre-
quently from cancer of the gum than from
cancer of any other part of the oral cavity
except the mucosa of the cheek. (36.3 per
cent). In the present series of cases there
was found no visceral involvement. Crile9
states that in a study of literature pertaining
to cancer of the head and neck it is shown
that among 4,500 reported autopsies, in only
1 per cent was secondary foci found in distant
organs or tissues. Ewing1 o states that me-
tastases in the organs are rare, but have been
observed in the liver, heart, adrenal, and
mesentery.
Cause of Death — From the above statements
it may be deducted that when death results
from a cancer of the head or neck, it is be-
cause of local and regional development of the
disease, not by distant invasion.9 The usual
exodus is that the floor of the mouth and
tongue are invaded with metastasis or sepsis
in the submaxillary lymph nodes, terminating
in cellulitis of the whole submaxillary region.
So death ensues from a combination of causes
— exhaustion from pain, sepsis, malnutrition,
and hemorrhage from the eroded mandibular
artery.1 One patient in this series died eighteen
days postoperatively of uremia and without
distant involvement.
HISTOPATHOLOGY — Since the pathology
of epidermoid carcinoma is the same in all
parts of the body, the presenting picture will
not be discussed. However, it should be point-
ed out that in this series five of the patients
were of grade I, two cases grade H, one case
grade III, and four cases ungraded. In Mar-
tin’s1 group of 113 cases, grade II was pre-
dominant.
Diagnosis — Martin1 states that a biopsy is
an essential part of the management of intra-
oral cancer. Bloodgood8 states, “It takes but
a minute to remove a piece of tissue and to
establish the diagnosis.” Kirkham4 says, “A
section of the tumor may be necessary to
complete the diagnosis.” Thoma5 says, “This is
the most important examination in making
the diagnosis.” Bloodgood8 states that in
doubtful x-ray pictures, the tooth in the in-
volved area can be extracted and the soft
tissue attached to it subjected to immediate
section and polychrome methylene stain. He
also says that in the future we are to see the
precancerous lesions of cancer of the gum
more and more frequently, and the early stage
of cancer of the gum when it can be recognized
with the microscope only.” The clinical ap-
pearance of the lesion may be confused witn
dental abscess, giant cell epulis, pregnancy tu-
mors of the gums, vitamin B deficiency,
fibrous epulis, leukemia, and miscellaneous be-
nign tumors as papilloma, etc. It is stated
by Geshickter11 that usually the area of de-
struction, because of its irregular and worm-
eaten appearance, and because of the absence
of new bone formation, can be diagnosed as
carcinoma in the roentgenogram.
Treatment — “Radiation, surgery and combi-
nations of the two all have a definite place
in the treatment of this disease.” Martin1 and
Geshickter11 stated that “carcinoma of the
lower jaw like carcinoma of the upper jaw
should be treated by cauterization and ir-
radiation. The prognosis is equally grave.”
Erich1 2 says “It is my opinion that routine
block dissection of the cervical glands is in-
dicated in most instances of epithelioma of
the lower jaw whether or not the lymph nodes
of the necks are clinically involved — in grade
IV epitheliomas, the use of external irradiation
to the neck may be preferable to surgical
measures.” Bloodgood8 says, since the intro-
duction of the cautery in 1910, “We have
quite a large number of five-year cures in
which the lesion on the gum of the upper or
lower jaw has been removed with cautery, of-
ten with the help of the soldering iron and
coagulation, after burning the tooth socket,
the alveolar border was bitten away and the
exposed remaining tissue was again cauter-
ized. When the x-ray shows no involvement of
December, 1945
Carcinoma of Gingivai — Stacy
499
the jaw, this method which preserves the con-
tinuity of the lower jaw gives just as good
results as resection. When there is x-ray in-
volvement of the lower jaw, resection must be
performed and then it is always best to com-
bine it with en bloc dissection of the glands
of the neck.” Kirkham4 says the prognosis is
very bad unless seen early, and an extensive
radical operation is performed together with
a complete neck dissection. Quick6 says:
“1. A combination of radium, x-rays, and
surgery offers the best means of treating
epidermoid carcinoma beginning in the
mucous membrane over the lower jaw.
“2. Radium, or radium and x-ray, is pref-
erable to surgery in dealing with the
diseases in the soft parts.
“3. Cases showing gross bone invasion
should be treated by jaw resection fol-
lowed by irradiation of the growth in
the soft parts.
”4. Radium and x-rays offer a great deal of
palliative relief.
”5. In the treatment of cervical lymphatics a
combination of x-rays, radium, and sur-
gery is preferable to a routine bloc dis-
section.”
The above conclusions came from 113 un-
selected cases, seventy-four of which died,
twenty-eight in whom contact was lost, and
eighteen cases living, four of whom are free
of recurrence better than five years, and one
case free of recurrence after four years. Six
of the cases had extensive bone invasion.
Thirteen cases were still under active treat-
-v
ment. Johnson and Daniel2 in 1943 reported 111
cases of intra-oral cancer, thirty of which had
growths originating in the gums— two arose
in the gum of the upper alveolus and twenty-
eight cases began as ulcers on the lower alveo-
lar margin. Five patients refused operation and
v/ith these the average duration of life after
onset of symptoms was fourteen months. Six
patients are alive and well four years after
operation. Four cases who were operated died
of recurrence thirteen months following opera-
tion. One death followed twelve hours after
operation. One died in a mental institution
three years after operation with no evidence
of recurrence at the time of death. Four pa-
tients were given radiotherapy, and their
average duration of life was 15.5 months as in
comparison to 17.7 months received from sur-
gery. All operative cases received postoperative
radiotherapy. Crile^ reports 224 cases of car-
cinoma of the buccal surfaces including lip,
mouth, tongue, and jaw. The treatment is not
altered for any one lesion in this series, so his
figures are of no value to this paper. Martin1
states that the survival of about 11 per cent
of cases for five years in comparison to no
survivals by surgery is a strong indication
that irradiation is a more useful method than
surgery in metastasis from cancer of the gum.
He also says that neck dissection if used in
gingival cancer should be limited to those
cases in which the primary lesion is under a
fair control and the nodes occur late in the
course of the disease.
In the present series of cases for treatment
of the primary lesion, three cases had unilater-
al resections, one had bilateral resection, five
were treated with radiotherapy, two refused
any form of treatment, and one lesion was ex-
cised with and including the periosteum of the
mandible at the site of the lesion. For treat-
ment of clinical metastasis which was present
in five cases, three had upper neck dissections,
one had a mandibular resection, and one had
a radical neck dissection. The longest survival,
twenty-eight months, was treated with radio-
therapy. Five of the cases were treated with
radiotherapy. Two of these are living — one
twenty-eight months and one thirteen months,
and without recurrences. Two died with dura-
tion of life after onset of treatment, seventeen
months in one case and ten months in the other
case. The whereabouts of one case cannot be
unfolded. Five cases were treated surgically,
four of whom are living (oldest being twenty-
seven months and shortest eight months) and
without recurrences with the exception of one
case who has recurrence. One case died eigh-
teen days postoperatively of uremia. Two pa-
tients refused any form of therapy. One of the
patients who received no therapy died eighteen
months after the onset of symptoms and one
is living nine months after onset of symptoms.
The average duration of life following onset of
treatment1 and including either of the above
described manners of treatment was 15.6
months.
Conclusion — It was my earnest desire at the
beginning of this paper to correlate and es-
tablish a standard form of treatment for car-
cinoma of the lower gingiva, but frankly, I am
of the opinion now that the treatment of this
carcinoma is in complete agreement with its
etiology and nothing of a striking nature has
been proved.
500
December, 1945
Cancer Control — ZiMmerer
BIBLIOGRAPHY
1. Martin, Hayes: Cancer of the Gums (Gingivae5) ,,
Am. J. Surg. 54:769, 1941.
2. Johnson, G. S. and Danieal, R. A., Jr.,: Gum
Cancer, Ann. Surg. 117; 78, 1943.
3- Gaini, G- : La curieterapie degli epitheliomi
gengivali, Radiol- Med-, 1: 351, 1921.
4. Kirkham, H. L. D. : Tumor of the Alveolar Bor-
der of the Jaws, Texas State J. Med-, 1: 351, 1921.
5. Thomas, K- H- : Cancer of Mandible, Am. J.
Orthodontic, 24: 994, 1938.
6. Quick, D: Carcinoma of Lower Jaw, Am- J.
Surg., 1: 360, 1926.
7. Johnson, F. M. : Certain Difficult Problems in.
the Treatment of Carcinoma of the Lower Jaw,
Radiology 280, 1925.
8. Bloodgood, J. D. : Oral Cancer, J. Am. Dent.
Assoc- 20: 1790, 1933-
9. Crile, G. W. : Carcinoma of the Jaws, Tongue,
Cheeks and Lips, Surg. Gynec. and Obst- 36: 159,
1923.
10- Ewing, James A- : Neoplastic Disease, 1940.
11. Geshickter, C. F- : Tumors of the Jaws, Am.
J. Cancer 24: 90, 1935.
12. Erich, J. B- : Cancer of the Jaw, Proc Staff-
Meet., Mayo Clinic 16: 77, 1941.
Cancer Control, A Doctor’s Program
EDMUND G. ZIMMERER, M. D.**
Des Moines, Iowa
The increasing mass of cancer propaganda
that reaches his desk, some of it promulgated
by non-medical groups, makes the doctor in-
creasingly conscious of the popular interest in
cancer and its control. He notes the concern
of governmental agencies and even profession-
al societies in the establishment of tumor
clinics and is aware of the endorsement given
such activities by organized medicine. Perhaps
he is invited to participate in the work of
tumor clinics, at least to the extent of re-
ferring his patients. He may even be asked to
speak at cancer meetings, often under lay
auspices, and he may occasionally be em-
barrassed at sharing the platform with a glib
lay speaker whose eloquence seems to put his
own knowledge of the subject to shame. No
wonder he sometimes asks himself where this
will lead.
The need for state control of communi-
cable disease has long been conceded. The of-
ficial supervision of motherhood and of in-
fancy, as in the EMIC program of the Chil-
dren’s Bureau, and even of the child of school
age is accepted with more or less reluctance.
The treatment of the venereal diseases under
public auspices is acknowledged as the best
means of controlling their infectiousness and
preventing their spread. But the entry of pub-
lic health into a field which deals with a condi-
tion not proved infectious and definitely shown
to be noncommunicable, in which the incidence
has been little influenced by treatment, seems
to portend a ruthless invasion by the state
into the whole realm of medical practice from
pediatrics to geriatrics.
The program of cancer control was not
organized by public health authorities, govern-
mental agencies, or any professional group,
but has evolved from a popular demand. It
did not arise because of any revolutionary
discoveries in either the prophylaxis or treat-
ment of cancer, or even of any definite know-
ledge as to its underlying causes. It is the
outgrowth of fear caused by the increasing
incidence of cancer. When any condition rises
in a quarter of a century from fifth to second
place among the leading causes of death, it
obviously becomes a matter of public con-
cern.
Congress, in the first bill in history to be
sponsored by the entire body of the United
States Senate, took official cognizance of the
popular sentiment in 1937 when it appropriat-
ed funds for the National Cancer Institute.
The American Society for the Control of Can-
cer, now known as the American Cancer So-
ciety, Inc., was organized in 1901. At first it
was a purely professional society whose mem-
bership included many leading physicians and
pathologists. Later it enlisted interested lay-
men and more recently has extended its ac-
tivities by establishing a Field Army which
has undertaken a widespread program of lay
education, always in cooperation with medical
societies.
The first public health recognition of the
cancer problem was in 1925 when a lay group
headed by a prominent Catholic clergyman
succeeded in securing an appropriation from
the General Court of Massachusetts for the
care of cancer patients. Thanks to the far-
sightedness of Dr. George Efigelow, part of
these funds was used for the study of the
preventive aspects of malignancy. Thus, Mass-
achusetts became the first state to establish
a program of cancer control. To date nine
♦Reprinted through courtesy of Journal of Iowa Sta te Medical Society and the American Cancer Society.
♦♦Director, Division of Cancer Control, Iowa State Department of Health.
501
December, 1945 , ,,lV
states have full time personnel engaged in
this work, and all health departments, are
giving cancer control more or less attention.
Hence, we behold an almost ideal setup
for the solution of jwiy public health problem.
We have a widespread phbiic interest, with
press, pulpit, school, and every avenue of edu-
cation willing and ready to do its part, a
government anxious to give such aid as it can,
rst.ate health departments everywhere giving
it more aad more attention, countless re-
searchers aided by public and private funds
•carrying on intensive study in cancer genesis.
All these, money, legislation, and organization,
are helpless to accomplish anything without
the willing cooperation and leadership of the
doctors in the hospital, in the city, in the
rural home, everywhere.
Obviously a completely satisfactory control
program must await at least the discovery of
the cause of cancer or a more thorough un-
derstanding of its nature, if not a specific
remedy or some prectical prophylaxis. Phy-
sicians would be the first to recognize that we
cannot wait till we know all about a disease
to do something about it, that we must use
available means and knowledge to the best of
our ability.
Early and accurate diagnosis and prompt
and adequate treatment are the keynote of our
present program of control. Early diagnosis
implies that the patient comes early to the
physician and that the physician be qualified
to act without delay. To that end it must be
universally recognized by the public that
cancer begins as a local disease and that
while it is in that stage it is generally curable.
We must strive to make all people alert to the
early signs of malignancy and prompt in seek-
ing competent medical aid. Here lay education
is our most important available means. Such
education must be neither technical nor de-
tailed. It must be simple, easily understood,
and above all, motivating. The facts about
cancer must be disseminated in the school and
home, in the family, and in social circles to
be effective. Lay organization is of the great-
est assistance in giving us an entree to the
very people most in need of education.
True, there are disadvantages to campaigns
by unofficial and particularly lay organizations
aside from their frequent lack of dignity, but
their practical value has been amply demon-
strated in the fight against tuberculosis, vener-
eal disease, and infantile paralysis. Whether
"We like it or not, lay education in health mat-
ters seeips best accomplished by campaigns,
withl(balyhoo, posters, buttons, exhibits, and
distribution of literature. Such programs can
be better carried out under ; lay than profes-
sional auspices, but must be restrained and
directed byj* ethical and experienced leader-
ship. r: <£ ■
The widespread interest and the alarm creat-
ed by misrepresentation and ignorance of the
truth about cancer offer a fertile field to
the charlatan and the quack which' can be
combatted only by a unified and authorita-
tive program of education. Education implies a
general dissemination of knowledge based on
accurate conclusions drawn from known facts.
In cancer, as in other diseases, this involves
statistical evaluation of a significant universe
such as is more readily accessible to a pub-
lic health department than any other agency.
Constant research and new discoveries con-
tribute ever changing views as to the nature of
malignancy, which must be quickly and care-
fully sifted to prevent the too ready accept-
ance of promised cures and yet make prompt
use of these means which have merit for the
suffering public. Only a centralized authorita-
tive body close to organized medicine, the re-
search laboratory, the hospital, and the clini-
cian, and one which enjoys the confidence of
the physicians and the public alike, can co-
ordinate the conflicting trends of thought to
avoid inconsistency. Only such a body can son-
trol and direct lay activity in health matters
and coordinate them to professional guidance.
The function of the health department,
then, continues to be that of correlator and
liaison between the public and the physician.
Its objectives cannot be attained without the
confidence and cooperation of all agencies
concerned, and least of all without the good
will and active support of the doctor. Indeed,
“the doctor is an integral part of the plan of
public health administration just as the law-
yer is part of his court.”1
We cannot shut our ears to the cry of the
public that something be done about cancer.
The people have spoken and in a democracy
“the people should have what they want, but
they must be protected from exploitation.
They should have a voice with their physicians
in the administration of their health pro-
grams.”1 They need and desire medical leader-
ship, and nothing is gained but much is lost
by our refusal to give it. v
1- E. W. Rowe, Better Health, Nebraska State
Department of Health.
502
Cancer Control — iZimmerer
December, 1945
In the program of cancer control the doc-
tor is the key man. On his degree of sus-
picion, upon his ability to recognize precan-
cerous or early lesions, upon his recommenda-
tions depend not only the success of the
program but, more important, the life or
death of the individual. The first doctor seen
by the cancer patient has more to do with
the ultimate outcome of the case than the
surgeon, radiologist, specialist, or clinic. Such
responsibility imposes the obligation of being
informed and competent or at least willing
to seek competent consultation.
Unfortunately, too many doctors still have
an ingrained pessimism regarding cancer that
is not justified by the facts, and which re-
acts to the detriment of their patients. Al-
most 40,000 five year cures of definitely
authentic cases of malignancy in the archives
of the American College of Surgeons attest
the curability of some cancers. Optimism is
an important corollary to cancer control.
Delay in the treatment of cancer is danger-
ous. If the delay is due to the patient’s ignor-
ance or fear, it is bad enough; but if it is due
to the doctor’s carelessness or incompetence,
it is practically criminal. The doctor’s attitude
plays an important role. If he makes light of
a lesion, the patient will not regard it serious-
ly either, and if he is instructed to return for
further examination at some indefinite time
he will be apt to postpone or neglect action
until it is too late.
On the statistical basis it may be presumed
that one in every 133 patients seen by a phy-
sician in Iowa is a cancer patient. 2 That
more cases are not dignosed may be due to
the low degree of suspicion on the part of
the physician or to his indifference to preven-
tive medicine. If he is consulted for a cut
finger or a sprained ankle, he does not bother
to question his patient about the apparent
leukoplakia on his lip. In this age of specializa-
tion, we are drifting from the beneficial habits
of the old family doctor. Preventive medicine
not only rebounds to the patient’s advantage
but is remunerative as well.
Temporization with lesions of skin cancer
is a common cause of delay that can be attri-
buted to doctors.* * 3 Irregular uterine bleeding is
often charged to menopause and the doctor
2. Luis I. Dublin, Metropolitan Life Insurance
Company, Letter of November 7, 1943.
3- Connecticut State Department of Health.
is too reticent to make a speculum examination^
Even more common is our ready acceptance
of the patient’s own diagnosis of piles and
neglect to make a simple examination. In
fact, most of our mistakes are due not so
much to our inability to recognize signs as to
our failure to look for and find them.
The educational program of the Field Army
stresses the importance of periodic physical
examinations, but unless such examinations
are thorough they not only fail to discover
early cancer and save life but serve to dis-
courage the patient and discredit the whole
program. A mere history, taking of blood
pressure, a casual auscultation of the chest,
and a urinalysis will not always reveal cancer
or permit us to give the examinee a clean bill
of health.
The following points in the examination of
an individual for cancer are suggested as being
essential :
Examination of the lips, tongue, cheeks,
tonsils, and pharynx for persistent ulceration,
especially in the presence of a history of
hoarseness or persistent coughing. In the lat-
ter case, a roentgenogram of the chest may
be needed. Examination of the skin, of the
face, body, and extremities for scaliness, bleed-
ing warts, black moles, and unhealed scars.
Examination of every woman’s breasts for
lumps or bleeding nipples.
Examination of subcutaneous tissue for
lumps on the arms, legs, or body.
Investigation of any symptoms of persistent
indigestion or difficulty in swallowing and pal-
pation of the abdomen.
Examination of lymphatic system for en-
larged glands, especially in the neck, axilla,
or groin.
Examination of the uterus for enlargement,
laceration, bleeding or new growths; bimanual
examination to determine condition of ovaries
and tubes.
Examination of rectum, always important
even in the absence of symptoms.
Examination of urine for blood.
Examination of bones and a roentgenogram
of any bone that it the seat of pain.
Examination of blood.
Careful examination and a roentgenogram
if indicated when the history or physical find-
ings point to abnormality in any other organ
or tissue. -
Cancer Control — Zimmerer
503
December, 1945
Biopsy, while ordinarily not a difficult pro-
cedure, is one of utmost value in confirming
the diagnosis but should not be rashly done.
In general, it should be made on the advice of
and in consultation with the pathologist.
The diagnosis and treatment of cancer are
always of grave importance — too grave most
times to depend on the judgment of a single
individual no matter how competent he may be.
No matter what the physician’s professional
qualification, he cannot hope to recognize can-
cer in its every possible manifestation; and if
he could, he would not be able to recommend
appropriate treatment in every case. Thus,
“Cancer has ceased,” as Ewing says, “ to be a
one man job.” Tumor clinics divide responsi-
bility, make for earlier, more accurate, and
definite decisions in diagnosis and treatment,
and encourage better training in both the rec-
ognition and therapy of cancer. Tumor clinics
may be established by county medical societies
in cooperation with the State Department of
Health. A subsequent article will deal with
their organization, benefits and use. Thus far
four are active in Iowa.
Reference to a tumor clinic does not ex-
clude the patient’s own physician. On the
contrary, it enhances his position. No patients
are accepted unless referred by a physician.
The personnel of the clinic is selected by the
local medical socity. The referring physician
is invited to participate in the examination and
discussion of the case. All reports and treat-
ment recommendations are made to him and he
alone determines whether they shall be carried
out, and where and by whom.
The minimum obligation of the individual
physician to the program of cancer control is
that imposed by his professional responsibility
and common humanity, to make himself com-
petent. He must be suspicious of malignancy
in every obscure case. He should be alert to
the earliest, even precancerous manifestations
of the disease. He should have available lab-
oratory, x-ray, and other diagnosis facilities
and be ready to seek competent consultation.
And withal he should develop a reasonable
optimism regarding the outcome of cancer
therapy.
As a group, the profession can contribute
to the training of its members. Cancer thera-
py, despite the fact that we still do not know
all about the disease, is not static. Amazing
advances have been made in recent years,
especially in cancer of the breast, uterus,
mouth, the buccal cavity. The medical society
should have an active cancer committee whose
function it is to bring modern thought on the
subject before the society by means of frequent
papers, symposia, and the like. It might well
consider the establishment and maintenance of
a tumor clinic. One of the principal benefits
of the clinic is its professional training. Doc-
tors should be encouraged to attend its clinical
sessions, and frequent clinicopathologic con-
ferences should be held.
The committee could develop higher stand-
ards of service in the community by urging
more thorough examinations of potential malig-
nancies, emphasizing the important ^steps in
a complete physicial examination, pointing out
the value and dangers of biopsy, securing bet-
ter records so that treatment methods can be
better evaluated. A precise history and def-
inite diagnosis are indicative of the quality of
professional care the cancer patient is receiv-
ing. The same committee might well check
on unorthodox treatment or unauthorized
practice in the community.
If the doctor or the medical society desire
to extend their activities beyond the range
of purely professional interest, they might
properly consider the arranging of law meet-
ings for the extension of health education to
the public and cooperation with interested
agencies. Professional activity is lagging far
behind public interest in cancer. Apathy,
jealousy, and personal prejudice must not
blind us to the prevailing trends in preventive
medicine. The doctor’s place in this as in
every program to fight disease and promote
health is in the forefront. His leadership
is desired and welcomed. The public and the
state recognize their dependence on the doc-
tor; without him there can be no effective
progress in any public health activity.
The program of cancer control, born of
need and of fear, is no exception. The pro-
gram is not state medicine. It is not a lay
project. It is and must be and always shall
be a doctor’s program.
Atheism is rather in the lip than in the
heart of man.
— Francis Bacon
Penicillin for Venereal Disease
An Editorial by Morris Fishbein, from December 1945, HYGE1A
Since penicillin is now generally available
throughout the country, great danger
exists that people who may try to treat
themselves by taking penicillin by mouth, may
really do themselves more harm than good.
The National Research Council warns against
self-treatment with penicillin for the venereal
diseases. For more than two years the vari-
ous ways in which penicillin can be used in
treating gonorrhea and syphilis, and the dos-
ages necessary for successful treatment, have
been studied in the large clinics of the United
States. The research was coordinated by the
Committee on Medical Research of the Office
of Scientific Research and Development, and
officers of the U. S. Army, Navy and Public
Health Service cooperated in the investiga-
tions.
Now it has been established that penicillin
practically always cures gonorrhea — some-
times called a dose, or strain or clap — in one
day, provided that the drug is given in suf-
ficient amounts. However, people who have
had penicillin treatment for gonorrhea should
have their blood tested by the Wassermann
or Kahn tests or some of the other tests for
syphilis for several months after to make
sure that they were not infected at the same
time with syphilis. The small doses of peni-
cillin that are used for gonorrhea do not cure
syphilis. Sometimes they serve to cover up
or mask the presence of the syphilis by stop-
ping the seriousness of the symptoms with-
out controlling the disease. Although peni-
cillin at this time seems to be the best, safest
and quickest method of treatment now avail-
able for syphilis, the ways in which it can be
used for all of the different forms of syphilis
are still under investigation. The value of the
drug in recent infections with syphilis has
been established and it has been proved that
the earlier a patient gets treatment, the bet-
ter his chances of cure. Penicillin is also
valuable in preventing syphilis from appear-
ing in unborn babies by giving the treatment
to infected, expectant mothers. Penicillin has
proved useful in checking some of the late
forms of syphilis, such as that which attacks
the brain and the spinal cord, and diseases
like general paresis or softening of the brain
and locomotor ataxia, which are also due to
the organism of syphilis.
Fortunately, penicillin is a non-toxic drug
when compared with arsenic, bismuth, mer-
cury and some of the other drugs previously
used in treating syphilis.
In its report, the Committee on Venereal Dis-
eases of the Division of Medical Sciences of
the National Research Council provides also
some words of caution. Because of the char-
acter of the venereal diseases, the committee
does not yet advise treatment of syphilis with
penicillin given by mouth. Injection of the
drug into the muscles is certain in getting
penicillin into the tissue. The injections must
be given, however, every two to four hours,
day and night, for periods of time as long as
7i or 8 days, and sometime even longer. In
some cases of syphilis which are especially
severe or which have lasted for a long time,
arsenic, bismuth or the fever treatment must
be used together with the penicillin, or after
the penicillin treatment, in order to make
certain that the disease is fully controlled.
People who have had penicillin treatment must
be checked again and again by complete ex-
amination and by use of the Wassermann or
similar tests in order to make certain that they
have not relapsed. In cases in which the dis-
ease does show up again, it is necessary, of
course, to repeat the treatment.
Experience in the large clinics has shown
that the blood test may not become negative
after penicillin, or any other form of treat-
ment, particularly when patients have had the
disease for a long time. It is not essential,
however, that the blood test become negative
in such cases for the disease to be fully con-
trolled. Failure of the test to become negative
right away should not discourage the patient.
Remember, however, that it is never safe
for any one to treat himself for syphilis with
penicillin or any other drug in any manner.
When the doses of the drug are too small,
when the timing of the treatment is irregular
or unsatisfactory, or when treatment has not
been given for a long enough time, such self-
treatment may be more dangerous than no
treatment at all.
While medical science has made a tremen-
dous advance against syphilis and gonorrhea
so that it seems possible now to promise that
one day venereal diseases may be as fully con-
trolled as are typhoid fever and diphtheria,
research has not stopped.
504
December, 1945
Editorials
505
The Mississippi Doctor
Published monthly at Booneville, Mississippi.
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
W. H. ANDERSON, M. D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College .... Poet
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn-
L. S. Nease, M. D Vice-President
Newport, Tenn-
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M. D Vice-President
El Dorado, Ark.
A. F. Cooper, M- D Secretary-Treasurer
Memphis, Tenn.
Gilbert J. Levy, M- D Director of Exhibits
Memphis, Tenn.
E. M. Holder, M. D. C. R. Crutchfield, M. D.
F. M. Acree, M- D. H. King Wade, M. D.
Lawrence W. Long, M-D.
J G. Archer, M.D. W- Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M-D., Suite 412 Standard Life Building,
Jackson, Mississiippi.
JUST ANOTHER INCIDENT
A few months ago there was a nationwide
furor over the bureaucratic shortcomings of
the Veterans’ Administration. Shamefully in-
adequate and obsolete practices were exposed
in the veterans’ hospitals. But the rush of
events quickly pushed the incident onto the
back pages. And, like many such incidents,
the public has heard no more.
Here is a typical illustration of what would
happen if the whole country should be in-
cluded in a politically administered medical
system. Individuals would be subjected, as
the veterans were and perhaps still are, to
questionable or incompetent care. As indivi-
duals, they could do nothing more than vent
their displeasure. Trying to ferret out offi-
cials responsible for ill treatment would be
akin to grappling with one’s shadow. When
the situation became bad enough, a rash of
condemnation would appear in the press. In-
vestigation would be promised — as they were
in the case of the Veterans’ Administration —
a few of the most glaring faults would be
corrected, and then the evil system would
settle down for another twenty years or so
of dozing dogma and inefficiency.
This is no exaggeration. It is what would
be faced by the people if they permit state
or socialized medicine, whichever you wish to
call it, to settle upon the country. It is the
normal procedure of bureaucracy.
WITH GOOD WISHES
As we come to the last of the old year
and the first of the new, we are very grate-
ful to all of the friends of the journal, to
every reader, to every subscriber, to every
advertiser, and to every doctor who carries
a courtesy card. For two years our road has
been exceedingly hard and it is yet, but we
hope for a better day. You have been pati-
ent and considerate and this we appreciate.
The aim of this journal is better medical
service for our state and our nation. It owes
its growth and 'what measure of success it has
achieved to the support of loyal friends. May
we continue to merit your help and
your friendship.
We offer our deepest sympathy to Dr. J. S.
McLester of Birmingham, Ala., in the death
of his beloved wife on December 8, 1945. Dr.
McLester was to have appeared on the pro-
gram of the Northeast Mississippi Thirteen
Counties Medical Society at Tupelo on Tues-
day, December 11. He is a past-president of
the American Medical Association and is well
known throughout the nation. As an essayist
he is always interesting and informative.
On January 7, 1945, at the Heidelberg Hotel
the civic clubs of Jackson and the members of
the legislature will have as their guest speaker
Dr. Seale Harris of Birmingham. The four-
year medical school will be the topic of dis-
cussion. The civic clubs will have the members
of the legislature as their guests. No better
man could have been found in the nation than
Dr. Harris to address this body and to lead
the discussion on this important question. He
breathes the spirit of Southern medicine, he
is a well informed progressive citizen, and a
506
December, 1945
Christian gentleman of the first order. Mr.
Hayden Campbell is chairman of the United
Committee. This is a most impcrt?nt meeting.
§
The profession sustained a great loss in
the death of Dr. W. A. Toomer of Tupelo. He
was an able practitioner and in addition he
gave special attention to tuberculosis. He
was really a war casualty. His health had mot
been good for some time. What he could do
wTith safety was limited, but duty called and he
did not falter; the urge to serve forced him
onward and he carried on unto the end. It
was the same spirit with which our boys died
on the field of battle; if any difference, there
was a greater love for service, since he did
not have to go by military order. Deepest
sympathy goes out to the family.
§
The Southeastern Surgical Congress will hold
its session in Memphis, March 11, 12, and 13,
1946. This meeting should be well attended.
The Southeastern Surgical Congress furnishes
one of the very best programs of any medical or
surgical organization in the United States.
Make ready now to attend this meeting.
§
Everyone favors a bigger and a better hos-
pital system for our state. The people are
becoming more hospital-minded. But of course
the headstone of a good hospital system should
be a good four-year medical school that has
the vision to carry medical service by way of
the hospitals to all the people of the state.
First class medical service was applied in
the jungles on the firing lines in the war,
and to say it can not be carried to every
farm house in our state, put in reach of every
person needing it, is to admit the lack of
vision, of courage, and of application. The
application of medical service is too valuable
to be blocked by the selfish dollar mark. We
have some people, a few, who honestly think
Mississippi does not need a four-year medical
school.
Dr. J. Rice Williams of Houston, Miss.,
was elected president of the Northeast Mis-
sissippi Thirteen Counties Medical Society for
the coming year. No doctor in our state is
more loved and revered by the profession than
Doctor Williams. He is the embodiment of
medical integrity, a lover of justice, a very
versatile man is knowledge, and profound in
wisdom. He is a diplomat creditable to any
nation. His faith in the triumph of the right
is deep, his courage is strong, and his heart is
kind. He has been speaker of the house of
delegates of the Mississippi State Medical Asso-
ciation for a number of years. In this capacity
he has rendered fine service for the Associa-
tion. He possesses a sincere mental honesty
that leads his mind to follow truth to the end,
which warrants his being very able in his chos-
en specialty. It is exceedingly good to claim
h'm as a friend and to feel the inspiration of
his fine Christian personality.
§
It seems now from the studies on the
alcoholic problem in the United States that
about eighty per cent of the people consume
alcohol as a beverage and that the average per
capita expenditure of those so doing is about
one hundred dollars per person. The total
bill for the alcoholic beverage is therefore
about eight billion dollars per year, four times
as much as is spent on all church work we
are told. Just saying that forty per cent of
the people in Mississippi use this beverage
and that their consumption is eighty dollars
average per person, we should have a bill of
around thirty million dollars in Mississippi per
year. The total cost to human society would
be about ten times this much when every-
thing is considered. Anyway we are planning
a road program, and wisely, which will cost
sixty millions and we think it is big. This is
only twice our whiskey bill. Still we stagger
and go blind at the thought of putting up five
million dollars to put into operation a first-
class medical school to save the lives of peo-
ple, to help them live longer and more useful
lives.
Some recent investigations were made in
some industries. It was found that there
were more accidents between eleven and
’twelve o’clock than any other time. A study
was made to find the cause of it. It was
concluded that it was largely due to the
workers coming to work without their break-
fast. It was found that many rode twenty
to forty miles to their work, that a large
percentage had only a cup of coffee, many
had just coffee and toast, not many had a
regular breakfast consisting of a cereal, toast,
egg, and fruit. By eleven o’clock they be-
gan to become nervous and exhausted; hence,
the accidents.
December, 1945
Editorials
507
After thorough study along this line it
was concluded that a person should have at
least one fourth of his food if not one third
at breakfast, and that a regular well-balanced
diet of good food and enough of it makes for
mental efficiency, for vigor, strength and en-
durance. This is a most important revelation.
Everyone should heed the advice, especially
factory workers, any workers around machin-
ery, any who must be efficient. These reve-
lations should certainly be applied to school
children. The responsibility is upon the
teacher as well as the home.
Whiskey as a medicine has its small field
perhaps, but as a beverage, its consumption
is incompatible with the machine age in which
we live — wherein lies the doctor’s challenge
and opportunity to human civilization.
§
The color of Mississippi’s population is des-
tined to make a rapid change. The dark
cloud of the Delta is moving to the North and
to the East. Thrifty whites will take then-
place as we balance industry with agriculture,
as we make timber growing a major crop and
advance dairying and stock raising. This will
make an economic difference in favor of a
four-year medical school.
The malaria carrying mosquito has brought
a longstanding challenge to the medical pro-
fession, but her days are now numbered and
this disease which has taken such a high toll
in human life is on its way out.
§
Federal aid for the lower income bracket
for hospitalization and for medical and surgi-
cal fees is much better than to have fastened
upon us the Wagner bill in all of its damaging
ramifications. Personal effort should continue
to be inspired by meritorious service and the
patient-doctor relation should be guarded as
human life.
Be sure to do the brotherly act by your
brother in medicine as he returns from the
battle-field to civil practice. He will appre-
ciate a favor and it will enlarge your own
soul.
§
Health foundations for health centers should
be the order of the day in our state, especi-
ally for the small town.
As a rule if you wish to secure the best
nurse available, find one trained in a twenty-
five to one-hundred-bed hospital.
The discoveries of healing science must be
the inheritance of all. That is clear. Disease
must be attacked whether it occurs in the poor-
est or the richest man or woman, simply on
the ground that it is the enemy; and it must
FROM DR. BRYAN
Within the last ten days I have had many
visitors from the doctors of the state. These
hours will be remembered by me so long as
memory lasts. I will mention Dr. Charlie
Murry and Dr. W. L. Little. These friends
travelled long distances just to gratify me. I
hope that they got some pleasure from their
visit. Also the Monroe County Society met in
my home. A rather full attendance marked
the meeting in spite of the downpour of rain
turning to snow. Since I can do nothing but
sit and think, I have ample opportunity to
recall many happy hours I have spent with my
dear friends ?mong the doctors of the state
and outside territory. I repudiate the thought
that “Friendship is nothing but a name,” and
that friends are to be lightly held. Friends
are, indeed, my greatest treasure. Of these
I can not be bereft except by some mistake
of my own or by the reckless tattle of some
jealous tongue. My greatest consolation is
that, to my knowledge, I have not an enemy
in the world. May God grant that I may never
have.
Well, the time is not so very long until
we shall know what our legislators think as
to the propriety or necessity of having a
four-year medical college in Mississippi. I had,
to the best of my ability, tried to analyze
the situation and had decided that such a
college and an increased number of hospitals
would greatly benefit our people. I had de-
cided, too, that I would try .to aid in getting
the people to see and appreciate this fact.
But the fates decreed otherwise. My health
gave way on the fourteenth of last January.
Since then I have not been able to do or say
anything that might contribute help to the
undertaking. I shall not state my reasons for
deciding as I did on this question. I trust that
our representatives may not fail to grasp the
bigness of the matter or be influenced by
508
The Mississippi Doctor
December, 1945
those who are wholly ignorant concerning it
or who are niggardly in their approach to the
question. We are now a rich state and will
grow richer rapidly. Our population is des-
tined to increase rapidly, both in the rural
districts and in the urban sections.
With a Howdy-do to all my friends and a
sincere wish all the good things in life may
come to you, I am,
Your friend indeed,
G. S. B.
News and Comment
TENNESSEAN IS NAMED A.M.A.
PRESIDENT-ELECT
CHICAGO, Dec. 5.— (UP)— Dr. Harrison
Shoulders, Nashville, Wednesday was named
president-elect of the American Medical As-
sociation.
The A. M. A. house of delegates elected
Dr. Shoulders after the installation of Dr.
Roger I. Lee, Boston, as president of the as-
sociation. Dr. Lee will serve during 1946 and
will be succeeded by Dr. Shoulders at the del-
egates’ annual meeting next December.
*****
Keenly aware of the American health
problem— how to provide the people with
medical service commensurate with the
capacities of modern medical science — the
American Medical Association has chosen
a Nashville physician and surgeon to
guide its efforts to meet the challenge.
Dr. Harrison H. Shoulders will become
president of the association next year.
For the past eight years he has been
speaker of the house of delegates of the
organization, and at all times, since early
in his career, he has accompanied his work
in the field of medical inquiry and service
with a lively interest in the group activi-
ties of his profession.
The Tennessean’s rise to prominence in
medical circles began with his return from
overseas service with the army medical
corps in World War I. He otherwise has
been connected with public health work
as secretary and executive officer of the
State Department of Health and at a later
-date as president of Nashville General
Hospital. In private practice in Nashville
since 1921, he has earned wide note and
respect.
Under rising social pressure, the AMA
still is seeking an answer to the health
meeds of the American people. Its presi-
dent-elect will have an opportunity as
well as the task of leading his organized
profession toward a happy solution of the
problem, which will insure the widest pos-
sible benefit of the preventive and reme-
dial discoveries that continually enrich
the medical knowledge of the race.
The Nashville Tennessean
The above news will be received with
pleasure and approval by the doctors of the
mid-South and the nation as well. Doctor
Shoulders has served well as speaker of the
house of delegates of the Americal Medical
Association. In this capacity he was able,
smooth, and diplomatic. His alertness of
thought and easy flow of well chosen words
with a pleasing voice fits him well for the
fine piece of work he has been doing.
He well deserves this, the highest medical
honor in the world, and he will serve well.
The Northeast Mississippi Thirteen Counties
Medical Society held its fourth quarterly ses-
sion at Tupelo on December 11. The Calvary
Baptist Church was the meeting place. Dr.
W. J. Aycock presided as president with Dr.
W. H. Cleveland as secretary. Two of the four
essayists were absent because of sickness,
Dr. J. S. McLester of Birmingham and Dr.
W. L. Stalworth of Columbus. Dr. A. J. Stacy,
Jr., read a paper, “Epidemoid Carcinoma of the
Lower Jaw,” and Dr. John Dwyer presented
another, “Varicose Veins.” They were splendid
papers.
Twenty-five doctors were present at the
scientific session which it is believed is the
smallest attendance for the last quarter of a
century.
ANNOUNCEMENT
DR. THOMAS E. WILSON
announces
his return to private practice
INTERNAL MEDICINE
and
CARDIOLOGY
Medical Clinic Bldg.
910 North State (Street, Jackson, Miss.
December, 1945
Deaths
509
COLORED PHYSICIANS MEET
The Northeast Medical, Dental, Pharmaceu-
tical and Nurses’ (Society met at the office of
Dr. L. L. Rayford in Grenada for a program
on syphilis and a round-table discussion of
respiratory diseases.
Following the scientific session a banquet
was held, with eleven doctors attending. The
next meeting will be held in Corinth.
Nurses
Did you know that for the first time in
history, President Jefferson Davis of the Con-
federate States of America, issued an army
commission to a nurse? The estimable lady
was Miss Sally Tompkins, who to a great ex-
tent and by her own efforts established a hos-
pital in the capital of the Confederacy, Rich-
mond. Later when it was taken over by the
government, she was made a captain in the
regular army and continued in full control
over her hospital.
Among other noble and unselfish women
of the South during the War between the
States was Mrs. Ella K. Newsom of New
Orleans, who exercised much care in estab-
lishing relief societies which did nursing they
could among the Confederate sick and wound-
ed. It is recorded that she received instruc-
tions in Memphis.
Clara Barton was another woman who be-
came famous during this period of American
history, nursing the wounded, securing sup-
plies and aiding the needy everywhere, and
subsequently becoming the founder of the
American Red Cross. The usefulness of this
great organization is as the field it covers,
world-wide.
On June 22, 1944, President Roosevelt
signed an executive order making the Army
Nurse Corps an integral part of the army, the
personnel to receive the same pay and pre-
rogatives as other officers. On this date there
was approximately something over 40,000
nurses.
L. L. MINOR, M.D.,
Box 348, Route 4,
Memphis, Tennessee
I don’t know who my grandfather was; I
am much more concerned to know what his
grandson will be.
Deaths
DR- WILLIAM A. TOOMER
Dr. William Arthur Toomer, prominent Tupelo
physician, died from a heart attack in the Community
Hospital at 1:40 a. m. Thursday, November 22. He
was 62- Services were held at his home the follow-
ing morning.
Survivors include his wife. Ruth Gaither Toomer,
and daughters, Mrs. R. D. Bowles, Isola, Miss-, and
Mrs. F. L. Spight, Jr., of Tupelo, and four grand-
children.
Dr. Toomer was born in Clay, Miss-, Oct- 12, 1884.
He was the son of the late William Toomer and Mary
Spencer Toomer. Mrs. Toomer and he were married
Nov. 17, 1913.
Dr- Toomer was a graduate of the University of
Louisville, Louisville, Ky., in 1909. He practiced in
Tupelo from 1915 until his health broke and he spent
several years at Sanatorium. Returning to Tupelo
in 1939, he resumed his practice there where he was
one of the town’s best loved physicians until his
death.
DR. CHARLES HESTER
Dr. Charles F- Hester of Newton, died Tues-
day afternoon. December 11, at a Meridian hospital-
where he had been confined for treatment only a few
days. Even though he had been in ill health practi-
cally all this year, his death came as a shock to
relatives and friends.
Dr. Hester was a native of Neshoba County, hav-
ing been born on April 15, 1884, a son of the late
Frank and Eliza Jane Murphy Hester. He had re-
sided in Newton County for ten years.
He was a graduate of the University of Tennessee-
He serviced the Indian Reservation at Conehatta
since his return to Mississippi from Texas, where he
formerly resided. Dr. Hester was a member of the
Newton Methodist Church.
Surviving Dr. Hester are his wife, Mrs. Mable Jane
Peters Hester, Newton; five brothers, Will, Tom,
and Algie Hester, all of Union; A. G- Hester of Lytle,
Tex., and a number of other relatives.
Interpreting Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
PEDIATRICS
Convulsions In Infancy and Childbirth —
O’Neal, Gerald C., Nebraska State Medical
Journal, 30: 207 (June) 1945.
■t
The author is correct in saying “Convulsions
may occur as a symptom in a large number
of diseases in infants and children. In the
study and treatment of any patient suffering
from this symptom, it is highly important to
approach the problem with the determination
to find if possible the underlying cause.
“The differential diagnosis of convulsions in
infants and children requires the considera-
tion of a great number of etiological possibil-
ities. In this presentation, only the more
common and more important etiological fac-
tors will be mentioned.
“Birth to One Month of Age — During the
first month of life, a large percentage of
convulsions is caused by intracranial birth
injuries. Babies who have been subjected to
difficult labors and deliveries are apt to be
victims of this type of injury. Symptoms
of intracranial hemorrhage may be present
at birth or may not appear for several days,
depending upon the severity of the bleeding
and its position. Feeble cry, excessive som-
nolence or irritability, and failure to nurse
are symptoms to arouse suspicion of this
condition. Cyanosis, irregular respirations
and nystagmus are usually present before
convulsions are seen. Rigidity of the spine
and opisthotonos are often present and a
tense fontanelle is common. Muscular twitch-
ings and paralyses may be seen in any muscle
or group of muscles, and often precede a
generalized convulsion. Localizing signs are
not of too great significance in early life, but
should be investigated thoroughly to rule out
a subdural hemorrhage.
“Examination of the cerebrospinal fluid is
often an aid in diagnosis. The cerebrospinal
fluid in intracranial hemorrhage usually
shows blood, particularly crenated red blood
cells.
“Treatment should aim at controlling fur-
ther hemorrhage and at reducing increased in-
tracranial pressure if causing definite pres-
sure symptoms. The former may be accom-
plished by the administration of vitamin K and
by intramuscular injection of blood. A mini-
mum amount of handling and quiet are re-
quisites for lessening bleeding. Reduction in
increased intracranial pressure is favored by
repeated lumbar punctures, but it should be
realized that indiscriminate punctures may
produce further bleeding after it had been
stopped by the increased pressure. Sedatives
for the control of convulsions in intracranial
hemorrhage should be used judiciously be-
cause important localizing signs or symptoms
may be obscured.
“Cases showing convulsions may be treated
with sedative drugs, such as, phenobarbital in
small repeated doses.’’
It is stated that “Third in importance in
causing convulsions during the first month
of life is the group of acute infections. At
this period of life, upper respiratory infections
and intestinal infections head the list. Urinary
infections are often overlooked because of
infrequent urine examinations. Many other
acute infections obviously occur at this time
of life but they are not common.
Tetany of the newborn is probably more
common than is realized.
“During pregnancy hyperplasia of the
mother’s parathyroid glands may occur, caus-
ing a hypofunction of the fetal parathyroids.
After birth the lack of parathyroid hormone
permits a low blood calcium to develop with
ensuing symptoms of tetany, particularly con-
vulsions. Lack of urinary calcium, which can
Interpreting Medical Literature
517
December, 1945
be readily tested for, is suggestive of low
blood calcium, but the diagnosis must rest
on actual blood determinations indicating a
blood calcium level of 8 mg. per cent or less.
“Hypoglycemia of the newborn occasionally
produces convulsions. While more apt to oc-
cur in infants born of diabetic mothers, it
may occur in any infant. Studies show that
the blood, sugars of all newborn infants drop
to low levels during the first few days of
life. These low levels ordinarily do not pro-
duce symptoms, but if some other factor
causes further depression of the sugar level
symptoms can readily develop. It might be
well to keep this possibility in mind, and, in
the event blood sugars cannot be determined,
give a convulsive infant glucose solution either
by mouth or parenterally.
“One to Four Months of Age — In this age
group the majority of convulsions result
from acute infections. Febrile illness of all
types is frequently ushered in by convulsions.
The convulsions of pyrexia are as a rule
transitory and not a grave significance. The
diagnosis of febrile convulsions depends on
the presence of fever, general toxemia and
signs and symptoms of an acute infectious
process. r.
“Treatment is first directed toward the
seizure and as a rule simple measures are
effective. A cool or tepid sponge bath will
usually reduce the temperature several de-
grees, as will also a thorough irrigation of
the colon with lukewarm water. If the re-
duction in fever fails to stop the seizure,
sedatives should be given. Intramuscular in-
jections of a soluble barbiturate may be given,
but, usually one of the barbiturates, such as
seconal or nembutal, given rec tally will suf-
fice. These barbiturates are conveniently
and quickly given in capsule form. The cap-
sule should be perforated at both ends,
moistened with water and then inserted into
the rectum. These drugs given rectally usually
take effect within 10 to 20 minutes and may
be repeated in one hour if necessary.
“Four Months to Two Years of Age — Tet-
any, while much less common today than
10 years ago, is still an important cause of
convulsive seizures in this age group. The
majority of tetany cases are due to rickets.
Less common causes of tetany are excess
alkali administration, excessive vomiting,
hyperventilation and parathyroid insuffi-
ciency.
“The characteristic physical sign of tetany
is carpopedal spasm. It is frequently accom-
panied by laryngospasm. Generalized con-
vulsions may or may not occur.
Calcium may be given as a 10 per cent
solution of calcium gluconate intravenously or
intramuscularly. Three or four grams may be
required to stop the convulsions.
“Two Years to iSix Years of Age. — In this
age group, almost all etiological factors
causing convulsions must be thought of. A
number of less commonly thought of causes
deserve mention.
“Lead poisoning is occasionally seen, and
is usually due to tho child’s eating lead-
containing paint from furniture and toys.
“Treatment consists of controlling the con-
vulsions by heavy doses of sedative drugs,
and lessening the cerebrospinal fluid pres-
sure by repeated, or continuous lumbar
drainage.
“Strychnine poisoning may be met with and
is usually due to ingestion of candy-coated
cathartic pills containing the drug. Strychnine
poisoning is acute, symptoms appearing with-
in an hour after ingestion. Tonic /spasms and
opisthotonos occur, but the mind remains
clear. The muscle contractions are inter-
spersed with intermissions during which the
muscles are completely relaxed, an important
differential point when considering tetanus.
The slightest stimulation is likely to set off
a violent spasm. If the convulsions cannot
be controlled, death will soon follow from
respiratory failure and exhaustion.
“Treatment consists in stomach pumping at
once and then in controlling the convulsions
by means of sedatives in large doses. Sodium
amytal intravenously to the point of anes-
thesia is the drug of choice. The prognosis
is good if the child survives the first six
hours.
“An important cause of convulsions in
young children is acute nephritis. The diag-
nosis is made on the urinary findings, and
there is practically always an associated
elevated blood pressure. Intramuscular or in-
travenous magnesium sulfate is the drug of
choice in treating the convulsions. Magnesium
sulfate effectively relieves the arterial spasm
which apparently causes the cerebral symp-
toms. Magnesium sulfate may be given in-
tramuscularly as a 50 per cent solution. Two-
tenths cubic centimeter of this solution per
kg. of body weight may be given four hours
518
Interpreting Medical Literature December, 1945
■; ■"lejjJ Lst-.-. . • '?tv
until the blood pressure is definitely lowered
and the convulsions have stopped.
Encephalitis is not to be overlooked in
children piesenting convulsions. Encephalitis
may occur as a primary disease as well as
secondary to certain virus diseases, especially
measles, mumps, chickenpox and smallpox
vaccinations. Pertussis is a frequent cause of
convulsive seizures. Pertussis may cause con-
vulsions by an encephalitis, by intracranial
hemorrhage, by alkalosis induced by vomit-
ing or by asphyxia accompanying the
paroxysms. The treatment of the symptoms
of encephalitis is symptomatic. Convalescent
serum in the secondary types of encephalitis
is theoretically of value and should be given.
The various types of meningitis can be
diagnosed only by spinal fluid examination
and culture. With the exception of tubercu-
lous meningitis practically all forms of menin-
gitis should be treated with either sulfona-
mides or penicillin, and in some cases by a
combination of these two agents.
“Six to Fourteen Years of Age. — After the
sixth year idiopathic epilepsy is found as the
most frequent cause of convulsive seizures.
Idiopathic epilepsy is a diagnosis which
should be reserved for those convulsive cases
for which no organic or physiological basis
can be demonstrated.
“The treatment of epilepsy is directed
toward decreasing the irritability of the cen-
tral nervous system. Sources of chronic or
acute irritations, bad habits, and mental
stresses are to be sought for and renewed.
Good physical hygiene is important.
“The ketogenic diet plus fluid restriction
and a low salt intake is effective in control-
ling some epileptic patients, but it is difficult
to keep a child on such a regime. In most
cases of epilepsy, reliance must be placed on
drug treatment for the control of seizures.
Phenobarbital is still a good drug in epilepsy,
but dilantin is meeting with more and more
favor. Often a combination of these two
drugs gives the best results. The dosage of
these drugs varies from % grain to l-l/g
grains, two to four times a day.”
COMMENT
This is a most valuable article and should
be carefully read by every physician under
whose eyes it may fall. The author has
evidently had a great deal of experience as
well as good training and can be relied upon
in the suggestions listed in this article. How-
ever, we would issue a word of warning about
too frequent "spinal punctures in infants. In
our opinion there has been much damage
done by spinal puncture and there are still
two schools -of thought relative to the value
of such procedure; one of which urges spinal
punctures to relieve pressure to stop con-
vulsion and the other, when the pressure is
lessening, the hemorrhage will again reoccur
and the pressure is nature’s means of stop-
ping the hemorrhage. At least this is food
for thought to anyone having a newborn with
convulsions.
The time honored treatment of giving
blood intramuscularly and vitamin K at the
very first symptom of convulsion in the new-
born is still of great importance. As a pre-
ventive measure it is good practice to give
the mother vitamin K at the time of the
beginning of labor or before, and give the
baby vitamin K immediately after birth in
all cases.
SURGERY
Bailey, O. T., Ingraham. F. T.( et. al.,
“Human Fibrin As A Hemostatic Agent In
Surgery.” Surgery 18: 347-360, 1945
From the newer knowledge of the compon-
ents of normal human plasma and their in-
terrelationships in the mechanism of blood
clotting, there has logically developed the first
great advance in the attainment of hemostasis
since the perfection of the hemostatic suture
and ligature.
The authors report in detail certain experi-
mental work which has established the techni-
que on a firm basis, and they report subsequent
clinical trials in conditions formerly fraught
with danger to the patient.
The materials used were a preparation of
thrombin, a preparation of fibrin, and a prep-
aration of absorbable (oxidized) cellulose.
The fibrin and cellulose were used to hold
liquid thrombin solution in place sufficiently
long to permit clotting to occur.
It is emphasized that complete hemostasis
obtained in the usual fashion remains a pre-
requisite to good surgery. There are, how-
ever, certain instances where the suture, the
ligature, the silver clip, and other orthodox
measures are not practicable to use, and yet
in these very cases complete hemostasis may
.December, 1945 Interpreting Medical Literature 519
? be vital to the patient as for example in deal-
ing with lacerated wounds of the liver, kid-
neys and lungs. It is further remarked that
there is^a^ group of patients possessed of cer-
tain blood , dyscrasias which ^result in a
tendency to hemorrhage which cannot be con-
trolled by ordinary measures.
The author$..rj?ecount first a group of con-
trolled animal experiments in which thrombin
and fibrin foam were placed in wounds of the
liver, kidney and lung. In each instance the
intentional trauma provoked hemorrhage diffi-
cult or impossible to control by conventional
measures. In each of the above instances, a
solution of thrombin held in place by fibrin
foam speedily attained effective hemostasis. At
appropriate intervals the animals were sacri-
ficed and histological studies were made which
showed a minimal amount of tissue reaction.
It was demonstrated that fibrin foam and
thrombin were absorbed almost completely by
the end of fifty days.
It was further observed that when the ab-
dominal cavities of animals subjected to the
above procedures were re-opened there were
minimal adhesions which could be attributed
to the use of fibrin foam and thrombin. Like-
wise operations on the pleural cavity revealed
at later exploration a remarkable freedom from
postoperative adhesions.
Further experiments showed that the anti-
biotic agents penicillin and sulfadiazine might
be used in combination with fibrin foam and
thrombin without alteration either of tissue
reaction or final results. In other groups of
animals absorbable (oxidized) cellulose was
used in place of fibrin foam to serve as a
carrier for the thrombin solution and the re-
sults in this group were quite as good and in
every way comparable to results obtained with
the use of fibrin foam.
Following the above experimental work, the
authors advocated and used these substances
in more than 240 cases other than in the field
of neurosurgery. In every instance fibrin foam
and thrombin controlled the hemorrhage ade-
quately and in this series of patients more
conventional methods would probably have
been inadequate and hemostasis accomplished
only with great technical difficulty if at all.
Editorial comment. The use of thrombin
solution in connection with fibrin foam or ab-
sorbable cellulose as a means of securing
complete hemostasis where conventional
methods would be difficut or impossible repre-
sents a major surgical achievement and one
of great clinical importance.
Thrombin is now available commercially in
a readily usable form. The material has been
available on the author’s service for about one
year and has been used clinically in a number
of instances. Its use however has been limit-
ed due to the fact that fibrin foam and absorb-
able cellulose are not yet commercially avail-
able. Thrombin solution alone has the obvious
disadvantage that it flows off the surface to
which it is applied before a clot can form
sufficiently firmly to occlude moderate sized
vessels. The use of fibrin foam or absorbable
cellulose should eliminate this difficulty. In
one case on the author’s service it was neces-
sary to incise a solitary kidney in order to re-
move a deeply impacted stone. Hemostasis by
the usual methods could not be obtained. Topi-
cal thrombin was then applied as follows; the
assistant supported the kidney in such fashion
that the bleeding surfaces v/ere almost but
not quite approximated. The gloved hands of
the assistant formed a sort of dam about the
wound in the kidney. A solution of thrombin
was then flowed into the wound and complete
hemostasis resulted in less than sixty seconds.
A few mattress sutures were then put in p?ace
to serve solely as a support for the clot and
the wound was closed in the usual fashion
after inserting a Penrose drain. It was observ-
ed postoperativ£ly that there was minimal
drainage and this was not of bloody character.
ANNUAL CONVENTION
The American College of Physicians will
resume its Annual Meetings in 1946 and has
now definitely chosen Philadelphia, May 13-
17, inclusive. Headquarters will be . at the
Philadelphia Municipal Auditorium, 34th Street
below Spruce.
The meeting will be conducted under the
presidency of Dr. Earnest E. Irons, Chicago,
Illinois, and the general chairmanship of Dr.
George Morris Piresol, Philadelphia, Pennsyl-
vania.
The success of a war is measured by the
amount of harm that it does.
Every idea must have a visible covering;
every principle must have a dwelling-place; a
church is God within four walls; every dogma
must have a temple.
State Board of Health
Felix J- Underwood, M .D.
VENERAL DISEASE CONTACT
REPORTING
Veneral disease contact reporting by private
physicians is the subject*' of a study being
conducted by the State Board of Health in
cooperation with the State Medical Association
for the purpose of bringing more cases under
treatment at the earliest possible date. The
experiment puts into effect a new system
devised as the result of a survey made by more
than fifty private practitioners of the state.
It recognizes the physician’s lack of time for
interviewing, the need for . maintaining the
confidential relationship between patient and
doctor, and the desirability of each contact
being free to choose his own physician.
One of the primary features of this system
is a “self-interview” questionnaire which has
been prepared for the physician to hand to
infectious cases of venereal disease coming to
his attention. The patient fills in the names
of sex partners exposed, seals the question-
naire into an envelope without signing, and
mails it to a central post office box maintain-
ed at Jackson by the State -Medical Associ-
ation. There the questionnaires are opened by
a confidential secretary, notice is mailed to
each sex partner named, and then the question-
naire is locked into a secret file. The notice
does not specifically mention venereal disease
but only requests that the recipient seek out
his private physician within two days because
he, the recipient, has been exposed to a com-
municable disease. Recipients are requested
to present the notice to the physician who can
easily detect what disease is involved by de-
coding the number on the notice, which corre-
sponds to the number for the diseases listed
on the Monthly Numerical Morbidity Report.
After examination by the physician, the
contract is requested to mail to the confidenti-
al secretary a notice of cooperation. Recipi-
ents of contact notices who do not cooperate
and seek examination before two weeks have
elapsed will then be visited by a follow-up
worker of the State Board of Health and urged
to seek examination for their own protection.
The results of this system, now on trial, will
be reported in detail before the State Medical
Association at its next meeting.
* * *
The Separation Center at Camp Shelby has
been set up to screen all personnel being dis-
charged from the Army for the existence of
venereal disease. Primary and secondary un-
treated cases are being retained by the Army
for treatment with penicillin. Other cases
untreated, or incompletely treated, are being
interviewed and persuaded to complete the
therapy at a Public Health Treatment Center.
Cases are being transported by bus from
Camp Shelby to the rapid treatment center at
Brookhaven at the rate of over four hundred
a month. Cases of systemic syphilis are re-
ceiving combined penicillin, mapharsen and
bismuth treatment. Others showing neurolog-
ical involvement are being treated by the
State Fever Therapy Unit for neuro-syphilis.
This program has been developed in re-
sponse to requests from military authorities in
order to make possible more rapid discharge
of military personnel and to obviate with-
holding discharges for lengthy treatment at
the camp.
* * *
EDUCATION FOR RESPONSIBLE
PARENTHOOD
The need for more adequate resources for
youth guidance and premarital counselling has
lately become a serious concern. Civic organi-
zations, youth groups, parent-teachers associ-
ations, woman’s clubs and others have express-
ed the need for assistance in coping with prob-
lems which will enable young people to be-
come better citizens and homebuilders. The
request goes beyond the need for the develop-
ment of child guidance clinics into the field of
providing parents, teachers and youth lead-
ers with suitable educational materials in the
fields of social adjustment, emotional growth,
and preparation for parenthood. To help meet
this need the State Board of Health and the
State Department of Education over the past
two years have assembled a group of well-
520
December, 1945
State Board of Health
521
selected materials for the use of groups and
individuals interested in youth development.
Late, authoritative books have been added to
the State Board of Health Library and may be
borrowed by responsible individuals. A list
of the books available may be had upon ap-
plication to the library.
In addition to assembling materials, regular
training courses were conducted under the
direction of Dr. William G. Hollister and were
attended by physicians, nurses, child welfare
workers, youth leaders, parents and teachers.
Over one hundred individuals took advantage
of these courses to obtain a broader under-
standing of the subject and to prepare them-
selves to conduct discussion groups with adults
back in their own communities. It is estimat-
ed that approximately four hundred teachers
have benefited from this training.
Many private physicians have recently not-
ed increased demand for their functioning as
premarital councellor and have felt the need
of having just such packets of material as the
State Board of Health has compiled. More
than ever they look to the physician to ful-
fill the important role of adviser in solving
numerous social and marital adjustment prob-
lems.
* * *
MISSISSIPPI VITAL STATISTICS
1944
The Division of Public Health Statistics has
just completed a 126-page publication portray-
ing vital statistics for Mississippi in 1944. A
variety of basic tables are included interpret-
ing data compiled from records of births,
deaths, stillbirths, marriages, and divorces
collected through the Division of Vital Statis-
tics.
Among other things the study indicates that
the first five of the ten principal causes of
death account for 49.9 per cent of the total
deaths in the state during 1944. Of these,
the leading cause of death was heart disease,
a total of 3,537 deaths being reported. As in
1943, nephritis is again in second place with
intracranial lesions of vascular origin, cancer
and accidents in third, fourth, and fifth places
respectively.
Once again there is reported a population
decrease for the state. The total estimate
of 1,996,333 is 56,561 less than the estimate
for 1943. Both figures were based on war
not represent a true picture of pop.,
ration book registrations and as such nTS,
change although they do represent the best
estimates available for these war years. Ap-
plying percentages as shown in the 1940 cen-
sus, the color estimates for 1944 show 1,018,-
458 whites and 977,875 non-white.
The birth rate for Mississippi continues high
with a rate per 1000 total population of 28.3,
the white rate being 25.2 and the non-white
31.6. This represents a slight decrease as
compared with the total and the white rates
for 1943. The non-white rate remained the
same.
The death rate for the state, on the basis
of place of occurrence of death, remained the
same as for 1943, namely, 10.2. On realloca-
tion of deaths to place of residence of the de-
ceased, the rate dropped to 10.1, with 8.7 the
rate for white and 11.6 the rate for the non-
white group.
The maternal death rate, which has been
declining during the past several years, show-
ed a slight increase for 1944, having risen
from 3.9 in 1943 to 4.0 in 1944. In 1943
there were 233 maternal deaths in the state;
in 1944 there were 228. Of the 228 deaths
reported in 1944, 71 were white and 157 non-
white.
The infant mortality rate of 43.6 represents
a decrease of 3.1 as compared with the 1943
rate. More than one-half, or 1436, of the
total of 2481 infant deaths occurred within
the first month of life. Prematurity, injury
at birth, diarrhea and enteritis, influenza and
pneumonia lead as causes of death in this
group, the majority occurring under one week
of age. The increased attention to the Maternal
and Child Health program is expected to ac-
complish a reduction in the number of infant
deaths from these causes.
Tuberculosis again leads as a cause of death
among the infectiousu and parasitic diseases.
The rate of 37.1 per 100,000 population for
pulmonary tuberculosis is however 2.1 lower
than the 1943 rate. Of the 740 such deaths
recorded, 217 were among white and 523
among the non-white groups.
Thirty-four deaths from diphtheria, 96
deaths from whooping cough and 61 deaths
from malaria rank among leading causes of
death within the infectious and parasitic dis-
ease group. Of public health interest is the
fact that there were reported 67 deaths from
pellagra, 31 of these among the white and
State Board of Health
December", 1945
522
ion-white groups.
36 amon^and accidental deaths numbered
"with a rate of 91.2 per 100,000 popula-
tion. The 1943 rate for causes in this group.,
was 89.8. Of the 1821 such deaths 342 were
due to motor vehicle accidents.
There were recorded 4.471 fewer marriages
for 1944 being 41,559. There were 891 more
divorces in the state, the 1944 total being
6742, an all-time high for Mississippi.
Physicians interested in having a copy of
the publication, VlTAL STATISTICS, 1944
for the state of Mississippi, may obtain same
by dropping a card to the Division of Vital
Statistics, Dr. R. N. Whitfield, Director.
* * *
? r
The attention of Mississippi physicians is
again directed to the opportunity afforded by
the State Board of Health Medical Library in
keeping abreast of current medical literature.
With over six thousand volumes of books and
bound periodicals, it is rendering consider-
able assistance to the medical and public health
professions of the state. Physicians return-
ing from the services and others are finding
the library an excellent refresher source in
rounding out their knowledge regarding cur-
rent practices in the various fields of medicine.
Most books are loaned for 2-weeks’ periods
and can be borrowed by mail when the physi-
cian does ot have convenient access to the
reading room.
Recent acquisitions include:
I. Landsteiner, Karl — The specificity of serologi-
cal reactions, rev. ed. Harvard University Press, 1945-
2- Cannon, Walter B- -—.The way of an investigator
W. W. Norton Co., 1945.
3- Beckman, H. — Treatment in general practice.
5th ed., Saunders,- 1945-
4- English, O. S. & Pearson, G. H. J. . — Emotional
problems of living; avoiding the neurotic pattern.
W. W. Norton Co., 1945.
5- Rich, A. R. — Pathogenesis of tuberculosis.
Thomas, 1944.
6. Puffer, R. R. — Familiary susceptibility to
tuberculosis- Harvard press, 1944.
7. Leonard, M. L. — Health counseling for girls-
Barnes, 1944-
8. Stone,' H. & Stone, A. — A marriage manual-
rev- ed-, Simon & Schuster, 1939.
9. Stern, B. J. — American medical practice in
the perspectives of a century. Commonwealth fd.,
1945.
10. Mustard, H. S- — Government in public health.
Commonwealth fd-, 1945.
II. Thomas, G. I- — Food of our forefathers.
Davis, 1941-
12- Natl. Inst, of Health — Studies of typhus
fever. G- P. O-, 1945.
13. Med- Clinics of N. America —
— Symposiums on Internal medicine and rehabili-
tation, May, 1945.
— Symposium on medicine emergencies, (Mayo
Clinic No-), July, 1945. . ,
—Symposium on specific methods of treatment
(Boston No-), September, 1945.
g — Symposium on gynecology and obsterics- (Phil-
adelphia No.), November, 1945.
'14- Clinics —
or — Traumatic surgery. April, 1945.
<q — Management of cancer. June, 1945-
. — Management of common neurologic disorders,
August, 1945.
— -Obstetrics- October, 1945-
, 15. Appleton, J. L- T. — Bacterial infection, with
special reference to dental practice- 3d ed- Sanders,
1944. I
0 16. Felsen, J- — Bacillary dysentery, colitis and
enteritis- Saunders, 1945.
17- Gould, S. E. — Trichinosis- Thomas, 1945.
19. Pratt, Geo- K. — Soldier to civilian. McGraw-
Hill, 1944-
20. Steiner, L- R. — Where do people take their
troubles. Houghton, 1945-
21. Senn, M. J- E. & Newill, P- K. — All about
feeding children- Doubleday Doran, 1944.
22- Whipple, D. V. ■ — Our American babies; the
art of baby care- Barrows, 1944.
PREVALENCE CF COMML NIC ABLE
DISEASES IN MISSISSIPPI
Acute Poliomyelitis
17
8
10-4
Bacillary Dysentery
481
720
589.2
Dengue
0
0
-8
Diphtheria
191
123
108.4
Influenza
3204
3109
2874.8
Measles
97
67
163-8
Meningococcus Meningitis
1
5
4.8
Other Forms Meningitis
5
6
2-8
Pellegra [ 1 1
163
214
223-6
Pneumonia
738
737
708.4
Pulmonary Tuberculosis
161
156
150.8
Scarlet Fever
93
75
75.0
Smallpox
8
0
2-2
Tularemia
3
4
2.4
Typhoid Fever
9
15
12.2
Typhus Fever
28
16
16- 4
Undulant Fever
10
4
3.6
Whooping Cough
343
568
549-0
Womans Muxihary
President Mrs- L. J. Clark
Vicksburg
President-Elect Mrs. Stanley Hill
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
LUNCHEON
The Woman’s Auxiliary to the Central Medi-
cal Society held its annual Christmas luncheon
ai: the Edwards Hotel Tuesday, December 4.
December, 1945
523
c-£8j: .'is; i n
Woman’s Auxiliary
Mrs. George E. Riley, president, presided over
the meeting and extended a cordial welcome
to all members and guests.
Mrs. H. C. Sheffield offered a word of prayer.
Mrs. N. C. House, vice-president and pro-
gram chairman, introduced the guest artist,
Miss Charlice Minter, assistant speech director
at Belhaven College, who gave a reading,
“Jean Valjean and the Christmas Doll.” Ouida
Woody, acompanied at the piano by Cynthia
Knight, students at Belhaven College, rendered’
two beautiful vocal selections, “There’s a Song
in the Air” and White Christmas.”
Members who have been away with their
husbands in service and guests were presented.
Mrs. Harley Shands made a motion that the
January meeting be pretermitted since it comes
on New Year’s Day. The motion was seconded
by Mrs. J. W. Lipscomb, voted on, and accept-
ed.
An invitation was extended to all wives of
members of the Central Medical Society and
wives of doctors in the service stationed here
to become members of the Auxiliary.
Mrs. Riley brought a Christmas thought to
the Auxiliary..
The following hostesses were presented:*
Mrs. H. C. Ricks, Mrs. F. J. Underwood, Mrs.
Byron Alexander, Mrs. C. C. Smith, Mrs. I. C.
Huggins, and Mrs. N. C. House.
Auxiliary members present included: Mrs.
W. L. Hughes, Mrs. W. A. Smithson, Mrs. F.
A. Donaldson, Mrs. George E. Riley, Mrs. John
D. Carr, Mrs. H. C. Sheffield, Mrs. F. J. Un-
derwood, Mrs Lawrence Long, Mrs. Steve Co-
le, Mrs. Walter Simmons, Mrs. Adna Wilde,
Mrs. J. G. Thompson, Mrs. Harvey Garrison,
Mrs. Bristed Ware, Mrs. Walton Lipscomb,
Mrs. W. F. Hand, Mrs. Jimmy Blaine, Mrs.
Boyd Edwards, Mrs. W. C. Thompson, Mrs.
Van Dyke Hagaman, Mrs. P. R. Greaves, Mrs.
T. E. Wilson, Mrs. T. M. Moore, Mrs. F. D.
Hollowell, Mrs. B. N. Walker, Mrs. G. W.
Owen, Mrs. H. R. Shands, Mrs. Noel C. Wom-
ack, Mrs. C. B. Mitchell, Mrs. N. C. House,
Mrs. W. C. Redmon, Mrs. Byron Alexander,
Mrs. H. C. Ricks, Mrs. C. C. Smith, Mrs I.
C. Huggins and Mrs. A. L. Gray.
CANCER
Cancer takes the life of one person opt of
six in America. Thirty to fifty per cent of
these lives could be saved just with the facts *
we now have in hand. Cancer is not inherited*,
as far as medical research has thus far de-
termined. The public must be educated to go
to the doctor and the doctor must be prepared
with office equipment and trained nurse to
make every examination. A central hospital
in the state affiliated with the small ones in
which the nurses in training and the interns
should spend at least six months of their time
could help to cut down this terrible human
toll of life. Seventeen million people who are
now living in the United States will die of
cancer. For every 'practitioner a trained nurse
— preferably a nurse who has had training
in a small hospital and some time in the prac-
titioner’s office — would change this picture
As an aid in making examinations and as an
educator of the public, the nurse has unlimit-
ed opportunities. When the medical leader-
ship of the profession gets away from big
hospitals and comes to earth in the real field
of medical service recognizing the small hos-
pitals as aids, we can do big things.
Every doctor and every person in the coun-
try who can should send five dollars to the
American Cancer Society, 350 Fifth Ave., New
York 1, N. Y., for membership so as to help the
cause against this killer of human beings, and
to keep informed on what is going on.
Silent night, holy night,
All is calm, all is bright
December, 1945
Calcium Phosphate, Dibasic 0.500 6m. (7.75 grs.)
Synthetic Oleovitamin D 1 00 U.S.P. Units
(Activated Ergosteroi)
Thiamine Hydrochloride 0.111 mg.
(Vitamin Bx— 37 U.S.P. Units)
Riboflavin 0.223 mg.
(Vitamin Bs,G— 89 Sherman Units)
ltd
I — ** ■ ■ ni m . _
insures adequate^ intake of
these essential food elements —
• Calcium — Vitamins — Iron — are fundamentals of normal
and prescribed diets. WARREN-TEED CAL-VITARON pro-
vldes the needed supplementary Intake — check ihe formula
each CAL-VITARON Tablet contains:-
.
♦
Ferrous Sulfate 5.555 mg. (1/12 gr.)
During pregnancy and lactation — to supplement diets
— prescribe WARRENTEED CAL-VITARON.
Warren- Teed Ethical Pharmaceuticals: capsules ', elixirs,
ointments, sterilized solutions, syrups, tablets.
For Quality Pharmaceuticals,
Prescribe —
COLUMBUS 8, O.
WARREN-TEED
tHE WARREN-TEED PRODUCTS COMPANY
Medical Education for the Laity
EDGAP. HULL, M.D.*
• r
; i: New Orleans, La.
Everyone should accept without ques-
tion the evident fact that medical educa-
tion for the laity is necessary. Indeed, it
is inevitable that persons of all grades of in-
telligence will, because of the natural law of
self-preservation, seek and find medical knowl-
edge that is useful to them. Men will not be
deterred in their quest for knowledge outside
of tneir particular fields of endeavor by the
false dictum of the English poet: “A little
learning is a dangerous thing”; actually, a
little learning is dangerous only when one
fails to realize that it is just a little. Even
if we were to believe, as a very few still do
that lay peoole would be better off if thev
knew nothing at all about medicine, we should
still have to admit that it is wise to guide
them in their inevitable quest.
I presume to speak upon this subject onlv
because I am interested in it, not because I
am competent or experienced, my own prope/
field being that of medical education for the
profession at the undergraduate and graduate
level. My interest has arisen because I have
observed that the possession of medical knowl-
edge by laymen is not always an unmixed
blessing; attempts to impart medical knowl-
edge have produced bad as well as good ef-
fects. It has occurred to me that some of the
unintended consequences may be avoided if
the purposes of imparting medical information
to the laity are more clearly defined in the
thoughts of those who do the teaching, and
if the requisites which must be met. if these
purposes are to be attained, are carefully
considered. I propose, therefore, to set down
these purposes and requisites and to discuss
them. I shall also indicate a few medical sub-
jects which I believe should be fitted into the
scheme of general education, subjects which
should serve as a foundation upon which use-
ful medical knowledge may be built. At the
end I shall add a note about informal word of
mouth medical education, which I believe can
be very useful.
♦Presented before the Mississippi Public Health
Association, Jackson, Miss., Dec. 11, 1945. Professor
of Medicine and Director of the Department of Medi-
cine, Louisiana State University School of Medicine
Purposes
From the standpoint of purpose, there are
two kinds of education — liberal and useful ;
medical education, both for the profession and
the laity, should be of the same two kinds. It
is entirely erroneous to conceive that educa-
tion in any field should consist only of impart-
ing knowledge the use of which can be easily
foreseen; such knowledge, though of course
very important, fails to satisfy the heart of
man. He must know things just for the joy
of the knowing, just as he must have things
just for the sake of the having. Purely practi-
cal education is like that of an automobile that
is perfect in all respects so far as efficiency
of operation and comfort and safety are con-
cerned, but which lacks beauty of design and
the doodads which make for pride of owner-
ship.
Liberal education is based upon the pre-
mise that knowledge may be its own end;
that there is a purpose to education which
bears no material fruit. Aristotle divided pos-
sessions into two classes: “Those rather are
useful,” he wrote, “which bear fruit; those
liberal, which tend to enjoyment. By fruitful,
I mean, which yield revenue; by enjoyable
where nothing accrues of consequence beyond
the using.” Knowledge is liberal, then, wnen it
is sufficient of itself.
Who can deny that knowledge of medicine,
even though it helps us not one whit to stay
well or to get well, is interesting and enjoy-
able; that to have it gives us a sense of self-
satisfaction; that medical matters form an ab-
sorbing subject of conversation? Knowledge
of how we are made, of how our insides work,
of the world of microbes, of the diseases that
attack man (provided they do not attack us
in particular), is intensely enjoyable; of the
creations of God, living things are more in-
teresting to most persons than are inanimate
bodies; and man is to man the most interesting
of living creatures.
It should be noted that most of the articles
on medical subjects which appear in lay
periodicals and which are read avidly by the
public actually have a liberal rather than a
practical appeal. Certainly overdramatized ar-
ticles on hernia, malaria, cure of deafness, the
526
The Mississippi Doctor
January, 1946
fine art of diagnosis, and the Rh factor are
read not because the information is useful,'
but because it is interesting. (It is unfortunate
that from articles of this type the layman
often gets liberal misinformation rather than
liberal education.)
Yet liberal knowledge is in the long run
useful in a material way. Knowledge acquired
solely for the purpose of enjoyment can often,
at a later date, be put to practical use by in-
telligent persons, and makes even the less
intelligent more receptive to practical knowl-
edge which is imparted to them by others. In
the field of medicine, accurate though limited
knowledge on the part of the laity makes for
better, more cooperative patients, and requires
much less effort by the public health workers
in order to accomplish their aim of improving
the health of the people. If people were better
educated in medical matters, they would do
more of the things that they should of their
own free wills, as most things should be done,
and there would be less need for coercive
legislation designed to improve the public
health. The activities of quacks and charlatans
would be curtailed because people could see
that their claims were ridiculous, and medical
fads would be less likely to mushroom because
liberally educated persons would reject them
as being incompatible with facts which they
have learned.
More generally, there can be no doubt that
the more liberal is one’s education, the more
he knows about fields outside of the one in
which he works for a living, the better citizen
he is. I argue, also, that concentration on
purely practical education, even in the case
of the less gifted, is a dangerous trend in a
democratic country.
As regards utility, medical education of the
laity should be considered as having two aims,
which though overlapping are nevertheless dis-
tinct. The first is to help the individual to
improve or to maintain his own health and to
safeguard the health of his family. The second
is to effect improvement in the average health
of the community, state or nation. In doing
his part to accomplish the first aim, the per-
son educated acts as an individual or as a re-
sponsible member of a family unit; in fulfill-
ing the second, he acts by carrying out more
completely and with better understanding his
duties as a citizen.
Neither of these aims is apt to be accom-
plished in full measure unless both of them
are kept in mind when medical knowledge is
dispensed. Suppose, for example, that a cam-
paign of education is undertaken for the
purpose of preventing deaths from accidental
poisoning, and the principal emphasis is placed
upon the fact that there is urgent need for
prohibition or restriction of the sale of certain
poisonous substances such as barbiturates, bi-
chloride of mercury, and carbolic acid. The
campaign impresses a sufficient number of in-
fluential citizens, so that the needed laws are
passed. But unless legislation is carried to an
unreasonable extreme, individuals, and
especially children, are not protected against
accidental poisoning by useful household
agents such as lye, ammonia, dry cleaning
fluids, and pest poisons, or by sedatives or
stimulants prescribed by the doctor but which
are allowed to remain in the medicine cabinet
long after the need for them has ceased to
exist. Unless responsible members of the fami-
ly are made fully aware of the dangers of
these substances and of the precautions to
be taken in their use, storage, and disposition,
the campaign has in large part failed. The
better qualified the average individual is to
protect himself and his family, the less need
there is for laws to protect him against health
hazards.
Requisites
First, medical information imparted either
for liberal or practical purpose must be ac-
curate; only the truth should be told. As I
have already mentioned, much of the medical
information given out to the public is, un-
fortunately, incorrect, so that unhappy results
may follow if attempt is made to use it. As
nearly as I can make out, the principal causes
of inaccuracy are lack of knowledge on the
part of the teacher; his willingness to ex-
aggerate in order to achieve his- purpose, be
it liberal or practical; and the sacrifice of ac-
curacy in order to achieve simplicity. Lay
writers, who prepare articles on the basis of
interviews with well known physicians and a
little superficial study, are the worst offend-
ers on the first two counts, and professional
people on the last, but it is only fair to say
that inaccuracies due to all three factors are
not infrequently detectable in the efforts of
physicians to educate the laity.
Second, it must be understandable. Facts
must be presented in words the meaning of
which is known to laymen, the presentation
being carefully designed for complete com-
prehension by the persons to whom they are
to be imparted. The net result of presentations
January, 1946
Medical Education — Hull
527
which are not understood is the dissemination
of inaccurate information. It must be realized
that this requisite automatically limits the
breadth of the medical education of lay per-
sons. What the layman cannot grasp, he
should not be told. I believe that physicians,
in explaining to patients the nature of their
illnesses, are the ones who violate this requi-
site most frequently; the amount of medical
misinformation, widely spread by word of
mouth, which emanates from this source, is
astounding.
Third, it must be authentic; that is, it must
consist of established facts about which medi-
cal authorities are in substantial agreement.
New concepts and unproved claims should be
presented to the profession and subjected to
proper confirmation before they are given
to laymen, who are unqualified to judge the
points at issue. Premature release of claims
not yet subjected to criticism and adequate
trial lead to false concepts and confusion, and
often make things very difficult for the con-
scientious practitioner who learns of advances
in medicine from medical journals rather than
from the daily papers or weekly news maga-
zines. One of the most harmful trends con-
ceivable is the present tendency of lay writers
in popular magazines to discuss controversial
medical problems, and then presume to decide
which side is right and which is wrong. Usual-
ly the “old guard” are discredited and pictured
as obstructionists to medical progress; the
conclusions may lead to lack of confidence
in the conscientious scientists who realize that
change and progress are not necessarily the
same.
These are the positive requisites, the es-
sence of which is the first one — accuracy. As
corollaries of these, there are two negative
requisites as wrell.
First, medical education should not engender
fear, or tend to cause people to become ab-
normally preoccupied about their health. Al-
though fear is a potent stimulant of positive
action, it is also one of the most potent fac-
tors in the etiology of the neuroses, which are
more common and distressing than the or-
ganic diseases. Even the most carefully pre-
sented facts about disease may precipitate
neuroses in susceptible persons, among whom
are many of the most avid lay students of
medicine. Exaggeration designed to produce
action may cause neuroses even in well bal-
anced persons. I have seen many a normal
person made miserable by fear of venereal
disease, cancer, heart disease, or tuberculosis,
produced by efforts to control these diseases
through education. This requisite is best ful-
filled if medical instruction appeals to reason
rather than to emotion.
Second, it should not give rise to false hopes.
Such hopes are not likely to arise if medical
instruction is truthful, authentic, and under-
standable, but because some of these requisites
often fail of fulfillment, much unhappiness has
been produced. Persons with advanced hyper-
tensive disease have flocked to surgeons whose
operations on the sympathetics have been pub-
licized, or have pleaded for kidney extracts
which have never been advanced beyond the
experimental stage ; sufferers from crippling
arthritis have expected complete restoration
of function from injections of gold; miracles
are expected, almost demanded of the new
antibiotic drugs, some of which are not yet
even available to the practicing physician.
Most of the false hopes arise out of unauthen-
tie or misunderstood information.
Medical Subjects in General Education
One thing I advocate is that the history of
the pure sciences and of medicine be assigned
its proper place in the history taught in
schoois. History in its proper perspective can-
not be learned unless the role played by dis-
ease in shaping its events is considered; a
clear picture of the march of civilization can-
not be painted unless the doctor of each
period, as well as the prince and priest, is
depicted. Progress in combatting disease is
historically as important as advances in the
methods of waging war. I tnink that children
should knowr, for example, who proved that
tne blood circulates ’round and ’round as
well as who proved that the earth is round;
who invented the stethoscope as well as who
invented the cotton gin; who discovered mic-
robes as well as who discovered islands and
continents. In this connection, it is important
to emphasize that the pure scientists, the men
who have experimented and made observations
and deductions just for the sake of decreasing
the realm of the unknown, are the ones who
made the discoveries which others have later
put to practical use for the benefit of man-
kind.
It also seems to me that children should
learn about the world within them as well
as the world about them; about the factors
Medical Education — Hull
January, 1946
528
which make people sick as well as those which
cause rain and storm and earthquake; about
the tiny beasts that attack man as well as
the large ones that usually avoid him.
A Note on Informal Medical Education
Except for expressing a wish that liberal
medical subjects be included in the plan of
general education I have said nothing about
the means of disseminating medical knowledge
to the laity. I approve of the means which are
employed by all qualified organized groups:
the press, the platform, the radio, the poster,
schoolroom. Especially do I approve of the
means employed by the public health nurse,
who instructs by example, who teaches as she
serves — a missionary method. Her teaching
is informal and intimate, and allows for ques-
tions and clarification. Its content and the
manner of its presentation may be fitted to
the intelligence, education, and temperament
of the “pupil.” This is the most effective meth-
od of teaching, and I would like to see it
widely used for the dissemination of liberal
as well as practical medical knowledge. I sug-
gest that it be used not only by people who
make the public health their life’s work, but
by practicing physicians as well, who must
realize that they must be educators as well
as practitioners if they are completely to meet
their obligations to society. The method may
be used not only in professional but in social
contacts as well. We know that lay persons
will pass the information along, and may be
assured that as it spreads it is more accurate
than it would be had it been disseminated to
large groups in a formal manner.
Summary
Medical education of the laity has had bad
as well as good effects, the principal bad ones
being the engendering of fear and of false
hopes, and the undermining of confidence in
physicians. Bad effects have resulted principal-
ly, but not entirely, from articles written by
unqualified persons for the purpose of amus-
ing or thrilling the public rather than edu-
cating it. In order to increase its good effects
and minimize its bad ones, it must be liberal
as well as practical, and it must be accurate,
understandable, and authentic. The foundation
upon which practical medical education is to
be built should be laid in early childhood. In-
formal instruction by qualified persons is an
effective method which should be more widely
used.
The Management of Varicose Veins and Their Complications*
JAMES W. O’DELL, M.D., F.A.C.S.
Vicksburg Clinic,
Vicksburg, Mississippi
In dealing with varicosities of the lower
extremities, there are a few major facts with
which one should be familiar before attempt-
ing more than the most minor procedures in
general usage today. One of the first of these
is a knowledge of the gross and histological
anatomy of the venous system of the lower
extremities and, second, something of the phy-
siology of the venous system of this region.
For the purpose of this paper, I will deal only
with the sapheno-femoral system and more
especially with the long saphenous system, as
this is the vein most often involved in vari-
cosities with which we are called upon to deal.
The long saphenous vein has its inception on
the medial aspect of the foot, just back of
the great toe, then passes upward and slightly
backward toward the popliteal space, and
from just medial to the patella it moves
slightly anterior as it continues up the thigh
to join the femoral vein at the fossa ovalis.
The smaller saphenous vein begins on the lat-
eral aspect of the foot and passes just behind
the external malleolus to continue up the leg
to the popliteal space where it penetrates the
deep fascia of the leg and joins the popliteal
vein. However, before this occurs a number of
small veins are given off which join the long
saphenous vein as it continues up the thigh
in the subcutaneous tissue. Just before the
long saphenous joins the femoral in the
fossa ovalis in the groin, three small veins
drain into it from above. These veins are the
superficial circumflex iliac vein, superficial
epigastric veins and the external pedendal vein.
About two inches below the fossa ovalis the
saphenous is joined by two more small veins,
the lateral and medial superficial femoral
veins.
January, 1946
Varicose Veins — O’Dell
529
Veins as a whole are composed of three
layers, as are the arteries, the intima, media
and adventitia with its externa, but being un-
der much less stress from pressure their walls
are relatively thinner and less capable of with-
standing increased and constant stress and
strain than are the arteries. They also have a
system of valves within the lumen of the
vessels developed from the intima, the semi-
lunar valves. They are interspersed through-
out the entire venous system, and their normal
function is to prevent backflowing, once the
blood has passed beyond them. There is a set
of these valves just below the sapheno-femoral
junction, within the saphenous vein, as well
as other sets above the junction within the
femoral and iliac veins. There are from five
to seven pairs of these veins in all through-
out the course of the long saphenous system.
There are communicating veins between the
femoral and saphenous systems in the leg,
and these short communicators also have sets
of valves which prevent backflow of the blood.
The physiologic flow of the blood through
the lower extremities on its return to the
heart is promoted by the pressure of the ar-
terial blood through the capillary bed, and
is aided further by the pumping effect of the
contracting muscles while walking or doing
any form of activity which causes contraction
and relaxation of the muscles. The motion
is further enhanced by the negative pressure
created by the rise and fall of the diaphragm
during the act of breathing.
ETIOLOGY
There is no doubt but that there are many
complicating factors which play a part in the
etiology of varicosities of the saphenous veins
of the lower extremity of man. Among those
factors may be mentioned the upright position
of man. The saphenous vein although some-
what thicker than the deeper femoral is not
overlaid by muscle and heavy fascia, but only
by loose connective areola and fatty tissue.
In varicose veins, as in many other conditions
occurring in man, hereditary factors play
a part. Trauma and especially trauma to the
veins of the lower extremities incurred through
long and regular hours on cement floors and
around machine and work benches is im-
portant. Evidence of this as a factor is to be
found in the great percentage of men who
have spent a great many years in industrial
plants, who suffer from one degree or an-
other of varicosities of the veins of the lower
extremities. Infection and postoperative and
postpartal thrombophlebitis are known and
frequent causes. Pregnancy and pelvic tumors
are responsible in the female in many in-
stances, and there are many other factors
which have been mentioned as possible causes,
all of which no doubt play important parts.
PATHOLOGY
The changes encountered in varicose veins
are the results of increased venous pressure
on a thin-walled muscular tube with first
thickening, later thinning, tortuosity and sac-
culation of the walls. Dilatation of the walls
brings about a separation of the valves of the
veins and produces an incompetency of the
valves and a reversal of the normal upward
flow of the blood stream, producing stasis.
Into these static areas bacteria find their
way and a suitable media on which to thrive
and grow. The overlying skin at first becomes
congested and edematous. Later as the con-
dition progresses it becomes atrophied, fi-
brosed and pigmented, the venules of the skin
become involved and chronic ulceration of the
skin and subcutaneous tissues is the result.
SYMPTOMS
The symptoms most often complained of
are tired, heavy sensations of the feet and
legs, cramping of the muscles of the calves,
and swelling of the ankles and dorsum of the
feet especially at the end of the day. Very
often the swelling is accompanied by intense
itching and a dermatitis which is difficult to
relieve. The most outstanding symptom of
long standing varices is chronic ulceration of
the skin and underlying tissues which is so
often present. These ulcers heal slowly or not
at all when treated by ordinary means, and
are responsible for much suffering and loss
of time. In these cases ulceration is usually
found on the leg in some position just above
the ankle, surrounded by an area of indurated
and pigmented skin. The apparent extent of
varicosities is not always comparable with
the symptoms, as in many instances small
varicosities produce very debilitating symp-
toms and are accompanied by extensive pig-
mentation and ulceration, while quite large
varicosities may be for many years asympto-
matic, and unattended by complications. As
a rule all varicosed veins that remain un-
treated, however, progress toward irreversible
changes in the veins, skin and tissues involved
530
Varicose Veins — O’Dell.
January, 1948
so that ultimate radical treatment becomes
necessary. In large sacculated varices it is
not uncommon to have a spontaneous rupture
and hemorrhage, or hemorrhage resulting from
a small puncture wound into the saccule. In
all cases of varicosities, with ulceration, one
must keep in mind and rule out certain con-
stitutional diseases i which are often found
present. Some of these are lues, endarteritis
obliterans, cardiorenal and toxic thyroid dis-
ease. ; !
TREATMENT
Method of treatment of varicose veins varies
somewhat among men and clinics the country
over, but only in minor detail. Methods, for
the purpose of discussion, may be divided into
two classes according to the veins to be dealt
with — those amenable to conservative treat-
ment only and those requiring surgery and
supplementary treatment at the time of or
following surgery. However, before any form
of treatment is begun, one should be reason-
ably sure as possible that he has a clear
picture of the pathology per se, that is a cor-
rect and sound diagnosis. One must keep in
mind arteriovenous aneurysm resulting from
trauma or of congenital origin. If there is
sacculation just below the femoral crease, one
must be sure it is not femoral hernia. In the
presence of large varicosed veins in the lower
extremity, one must rule out the possibility
of obstruction of the femoral vein, and be
sure before treatment of any type is begun
that the varicosed saphenous vein is not a
compensatory collateral return circulation in
this extremity, in which case, splinting alone
is advisable.
Special tests are of proved value in esti-
mating the degree of pathology in a case
and are of equal value in determining the type
of treatment best suited to each individual
case. If the valvular arrangement in the veins
is kept in mind, indicated tests may be quick-
ly applied and results correctly interpreted.
For the purpose of this paper it is sufficient
to mention only three, and if these are
thoroughly mastered and their principles un-
derstood, one may study varicosities and ob-
tain a fairly clear picture of the extent of
pathology in each case.
First, the Swartz test, or percussion tes^,
is of value when the vein is well visualized
below the knee but is buried deep in the
thigh tissues. By percussing the varicosed
below and palpating the thigh above with the
other hand, the course of the vein may be
determined if the vein is varicosed, as the
column of blood will carry the impulse. Tren-
delenburg’s test is the test most commonly
employed to determine reverse flow in vari-
cose veins. This is not a difficult test to per-
form and to understand. The patient first
lies dqwn, the limb is elevated to empty the
varicosities, pressure is applied over the sa-
phenous at the sapheno-femoral junction, the
thumb usually being used as the medium of
pressure, and the patient is asked to stand
while the vein is inspected. If it is seen to
fill and become tense very rapidly, and from
above, the test is positive. If, on the other
hand, the veins are seen to fill from below,
but fill more rapidly when the compression is
removed, the test is still positive, and there
is incompetency of the valves of the saphenous
below the sapheno-femoral junction, and con-
sequently backflow at this point. When the
filling is from distant areas, and also from
perforators in the thigh or leg, but the vein
does not become more tense when the pressure
at the groin is removed, the test is negative.
On the other hand when valve incompetency
is proved at the femoral junction and in com-
municators in the thigh, we have a double
positive Trendelenburg test. When it is neces-
sary to test the patency of the deep femoral
vessels or to locate on the thigh the point
where perforators come through to the sub-
cutaneous tissues, Perthe’s test is most com-
monly used, and is of much value. This test
is performed by placing a tourniquet about
the thigh at the area where a perforating
varicosity is thought to be and having the
patient walk back and forth across the room
some twenty or thirty times. If the deep veins
are patent, the normal contracting calf muscles
will pump the blood into the deep veins below
the tourniquet leaving these empty. If the
test is positive, the emptied veins fill quickly
from above when the tourniquet is removed.
However, when the deep veins are occluded,
there would obviously be no emptying of the
superficial veins in this manner.
There are a number of other tests which
have been mentioned much in recent years,
most of which are based on the principles of
these three tests, and if these three are mas-
tered and carried out in a faithful manner,
they will be found all that are necessary in
January, 1946
Varicose Veins — O’Dell
531
the way of tests to deal successfully with vari-
cosities of the lower extremities.
Conservative or medical management is suit-
ed only to a selected few cases by choice and
in a few cases of necessity because of contra-
indications to a more radical type of treat-
ment. In those cases where conservatism is
the treatment of choice, veins of not too great
a degree of varicosity, and those below the
knee with proof of no perforators or back
flow above the knee, may well be handled
successfully by medical management. How-
ever, it must be borne in mind that because
the vein is not visible above the knee is no
criterion that the vein is net varicosed.
Tne methods used in these cases vary but
little at this time the country over, and some
form of sclerosing solution is used. We use,
as do many of the other clinics, sodium mor-
rhuate, 5 per cent solution. This is a sodium
salt of a fatty acid derived from cod liver oil.
The solution is injected into the vein on one
or two cc. doses, allowing four or five days
to elapse between injections. As the solution
breaks down in the vein lumen the fatty acid
irritates the intima of the vein wall and pro-
motes closure of and sclerosing of the vein
wall, and in many instances obliteration en-
tirely of veins suitable for this type of treat-
ment. However, many times these veins can-
nulate again to give further trouble. More
rapid results, I think, are often obtained if
the so-called dry vein technic is used. This is
accomplished in the following manner: After
the needle is inserted within the vein lumen
as much blood as possible is pushed out of
the segment to be sclerosed in each direction
and held away from the segment by the
fingers. The injection is now made and a firm
pad of gauze is applied over the area and held
firmly in place with elastoplast before the
fingers are released. As this almost exclusively
an office procedure, and is therefore done on
ambulatory patients, a good effect may be
obtained by wrapping the entire leg in an Ace
bandage at the completion of injection. In us-
ing sclerosing solutions there are a few pre-
cautions to be kept in mind and observed. The
first dose should be small and given very
cautiously, as a small percentage of patients
will be found who do not tolerate this ma-
terial, due to allergy. In attempting to ob-
literate so-called sunbursts or telangiectatic
areas that so often appear on the thigh,
especially in women, one must use considerable
care to be certain the needle is in the small ven-
ule that feeds the sunburst and not outside in
the tissues around the venule, or ip the skin, as
much damage may ensue due to pressure nec-
rosis. In spite of the fact that it is claimed
that sodium morrhuate will not cause necrosis
of the tissues, if a sufficient quantity is forced
in the tissues outside the vein wall necrosis
will follow. It is, therefore, very necessary
in routine injections to be sure the needle is
in the vein lumen and not in the wall or in
the tissues outside the vein entirely. It is
rather dangerous to inject a vein over or near
the tibial crest for if an unhappy effect is
obtained a very chronic and obstinate ulcer
is apt to result. This same caution applies in
the region of the malleoli or the bony portion
of the dorsum of the feet. The fact of the
matter is, that veins in the region of the feet
about the malleoli are so well protected by
shoes that treatment, other than the splinting
offorded by these, is seldom indicated. There
is an occasional case, however, which might
fall between those requiring a strictly medical
regime and those where radical surgery is
definitely indicated. -These are cases which
have one large perforator which usually ap-
pears about midthigh with demonstrable val-
vular incompetency below, and large vari-
cosities, but in which no valvular incompeten-
cy or evidence of varicosities can be found
in the saphenous system above. This is an
instance where a combined minor surgical
procedure followed by injections as indicated
is usually followed by good results. As a rule
these perforators lie just beneath the skin, and
can be reached through a very short trans-
verse incision at the point on the thigh where
the varicosity is found to terminate. This
point can easily be determined, using Perthe’s
test for the purpose. The skin is prepared,
and using a small amount of 1 per cent nova-
cain solution as the anesthetic agent, this is
injected in the skin only over the point se-
lected, a short transverse incision is made and
the vein elevated on a hemostat, clamped, di-
vided and the segments tied. Closure is with
two or three interrupted silk sutures and the
area is dressed with a small pad secured to
the skin with a small piece of elastoplast.
Short segments of the vein below this point
may be removed in the same manner as seems
best to the operator. Usually one or two seg-
ments are sufficient. These procedures, al-
though minor, should be done in the operating
532
Varicose Veins
-O’Dell
January, 1946
room, after which the patient may go home
to return to the office for dressings and for
removal of stitches, as well as for injection
of small varicosities which may remain follow-
ing surgery.
However, the greater number of patients
who come to the surgeon for treatment of
varicose veins do not come in either of these
classifications. They not only have severe vari-
cosities, but many and varied complications
and these complications are usually responsible
for their seeking help. First among the com-
plications which bring such a patient is the
chronic and intractible ulcer, and this ulcer
which has defied all the home remedies and
patented salves to effect a cure. The patient
feels, and quite naturally so, that a few treat-
ments from the surgeon should be sufficient
to undo all the bad effects of a long standing
and chronic condition. The first duty of the
surgeon, therefore, is to sell to the patient
a “proper bill of goods,” and in such manner
as to leave no doubt in the patient’s mind of
the many possibilities and, above all, not to
leave with the patient an impression that the
situation is a relatively ' minor affair. These
are the cases which in many ways tax the
ingenuity of the surgeon, especially when the
economic status of the patient is much in-
volved, which is often the case.
In those cases where chronic ulcer of long
standing is present, secondary infection is in-
variably present in one degree or another, and
before any plan of treatment can be instituted
it is necessary that the patient be hospitalized
for a few days and vigorously treated until
infection can be brought under control. This
can be best done perhaps by elevation of the
limb and the application of some form of an-
tiseptic wet dressing. Ordinary sterile normal
saline solution I have found to be an excellent
medium. During this period the surgeon will
have an opportunity to study the patient and
the offending venous system as well. Lues
should be ruled out, anemia corrected if pres-
ent, and if there is avitaminosis, corrective
measures should be taken. Above all, diabetes
must be ruled out in all cases of chronic and
intractible ulcers of the legs, in spite of the
fact that varicosities may seem to be the
etiology. In the vast majority of cases, radical
surgery cannot be contemplated for one reason
or another. One of the chief complications
preventing surgical interference in varicosities
is the presence of obstruction of the deep fe-
moral circulation, and return circulation is by
way of the saphenous. There are from time to
time other reasons than this why surgery can-
not be used. In these cases the Unna or Sooey
boot is of considerable value in splinting the
tissues, reducing the swelling and giving the
patient a general sense of security and well
being. In most cases where ulceration exists
of not too severe a degree, if one of these
boots is properly applied, improvement may
usually be expected after a period of two or
three weeks of treatment.
However, in using these boots some degree
of skill is necessary. The material is in the
form of a thick paste which must be warmed
in a double boiler, or water bath, before ap-
plication. It is then painted on the limb, be-
ginning with the foot. An ordinary paint brush
may be used for this, the foot and leg is then
wrapped or enclosed in a layer of gauze band-
age. This must be smoothly applied, no rolls
or wrinkles allowed, perhaps best being applied
in short sections of gauze bandage. The idea
is to give support and not to constrict. After
the first layer of gauze bandage, another layer
of paste is applied and so on, until about three
or four layers of gauze and paste have been
applied, the last covering to be gauze alone
held on by spiral strips of adhesive tape. The
patient may wear this from ten days to two
weeks depending on the activity of the pa-
tient. In some cases the odor may become ob-
jectionable to the patient and for this reason
the boot may need changing earlier. After
considerable improvement is obtained by use
of the boot, one may change to Ace bandage
to be worn constantly, except when in bed,
with continued good effect.
In those cases with severe ulceration with
secondary infection, and in which surgery is
contemplated, one need not wait for the ulcer
to begin the process of healing, nor indeed
for all of the secondary infection to clear
up, only for this to do so partly. If the ulcer
is not too chronic and intractible, healing
will progress during ambulatory treatment fol-
lowing surgical procedures.
I will not attempt to go extensively into the
several technics in use today. Many operators
feel that much of the vein should be stripped
away with the vein stripper. Personally, I do
not feel this is necessary, although I have
done this procedure a number of times. The
technic I usually follow, however, is not origin-
al, but1 1 have found it in general very satis-
January, 1946
Varicose Veins — O’Dell
533
factory in the majority of cases. It consists
of combined high saphenous ligation with mul-
tiple excision of indicated segments, followed
in ten days or two weeks by injection of re-
maining small varicosities with sodium mor-
rhuate solution as indicated. The patient is
given only moderate sedation and the leg is
shaved and prepared, including the pubic
region, before being carried to the operating
room. In the operating room, the skin is fur-
ther prepared with some form of antiseptic
solution — a combination of ether and alcohol
followed by merthiolate is very satisfactory —
after which the leg, or both legs as the case
may be, is draped for unilateral or for bilateral
high ligation. I have found no contraindication
to doing both sides during the same operative
period. Just prior to placing the patient on the
table, with the patient standing, I have found
it very helpful to make such areas as are
thought to be suitable places for diversion,
ligation and removal of vein segments. Aside
from the saphenofemoral junction, it is often
necessary to ligate and remove a segment in
the midthigh region medially, and again me-
dially and laterally just below the knee, the
lateral segment from the short saphenous
when involved, and in some instances again
in the calf region, but well back from the
crest of the tibia. These sites are usually the
greatest number of segments that need be con-
sidered in a given case.
As an anesthetic, 1 per cent novacain solu-
tion is quite adequate, and this is injected in
the skin and subcutaneous tissues in a suf-
ficient quantity. At the groin region I have
found an obliquely transverse incision placed
about one finger’s breadth below the crease
and about two or two and one-half inches
in length to be sufficient in most cases. As
we know, the long saphenous lies beneath
Scarpa’s fascia surrounded by fat tissue in this
region and is usually not difficult to pick up.
The vein is lifted from its bed by blunt dis-
section, clamped, and divided where found.
The distal segment is followed downward be-
low the superficial medial and lateral femoral,
these small vessels being divided and ligated,
after which the main body of the distal seg-
ment is clamped, divided and ligated, and no
further attention is given the distal segment
in this region. The proximal segment is now
followed into the region of the femoral fossa,
ligating as found. The small vessels which
join the main vein in this region, and the
proximal portion of the saphenous is clamped,
a segment is removed, and the stump is li-
gated within the femoral fossa. Distal to the
primary ligature, a transfixation suture is
used on all major vessels and silk is used
throughout. However, care must be used in
lifting or tugging on the stump or the femoral
vein may be injured and hemorrhage result,
or the femoral vein may be lifted so high it
becomes occluded in part, at least in the liga-
ture, and much damage ensue as the result of
a too diligent effort to tie the stump short.
Closure of the skin incision here is with two
or three interrupted sutures in Scarpa’s fas-
cia. The skin is then closed with end on end
mattress sutures and interrupted sutures of
fine silk. The area is cleansed with ether, a
very small piece of gauze is placed over the
incision and a piece of elastoplast is stretched
and placed firmly over the area and held firm-
ly until it adheres to the skin. Ligation and
excision of segments below are carried out
through very short transverse incisions over
the vein sites at points of election. The stumps
are ligated with a primary ligature, with a
transfixation suture distal in each case and
the skin is closed with two or three interrupt-
ed sutures only. Dressings are with small
pieces of gauze affixed in position with elasto-
plast. Dressings of this type are the most
satisfactory possible, I think, for ambulatory
patients. In those cases where there is a small
ulcer, two five-yard three-inch Ace bandages
are used to encase the entire limb, after proper-
ly dressing such an ulcer. The patient is then
to be ambulatory from the beginning, walking
at least fifteen minutes of each two hours,
except for six or seven hours for sleep each
night. This is to be kept up for a period of
ten days or two weeks. At this time, or about
the time all the skin sutures are removed, any
remaining varicosities may well be seen and
injection of these begun. In most cases which
are not of the most severe degree, three or
four injections are sufficient.
In those cases of chronic and intractible ul-
ceration, one, of course, cannot follow this
plan entirely, but it is advantageous to ligate
in these cases as early as possible, after which
every effort is exerted to prepare the ulcer
bed for grafting, and in many cases it is ad-
visable to excise the old ulcer bed entirely.
As a usual thing the ulcer bed can be pre-
pared in about one week. A very satisfactory
type of graft for these areas, and the method
534
- r • "•
Tulareonia — Murphree
January, 1946
I most frequently apply, is a Padgett split
thickness graft, removed with the Padgett
Dermatome, of 0.016 up to 0.022 of an inch in
thickness, removed possibly from the anterior
medial aspect of the thigh, and affixed firmly
to the prepared bed by interrupted sutures of
fine silk, with a moderately firm compression
dressing applied over vaseline strips placed
directly over the grafted area, which is not to
be disturbed for six or eight days. However,
ulcer beds of some considerable size may in
many instances be handled very successfully
with Davis’ pinch grafts. These are dressed
in much the same manner as described for
the Dermatome grafts. I have found vaseline
gauze a very splendid dressing to apply direct-
ly over the grafts of either, type. All of these
patients should not only have local supportive
treatment in the form of an Ace bandage v/ell
supplied, but should have in addition iron and
vitamin therapy as a general supportive
measure to aid healing and promote the gen-
eral well being of the patient.
CONCLUSIONS
(1) . Patients suffering from varicose veins
and their complications are individual prob-
lems.
(2) . Anatomy and physiology pertaining to
the veins of the lower extremities are re-
viewed.
(3) . Methods of diagnosis and diagnostic
tests are discussed.
(4) . Combination high saphenous ligation,
with subsequent injections of sclerosing solu-
tion in any remaining veins is recommended.
(5) . Treatment of chronic ulceration of the
legs by excision of the ulcer and grafting is
discussed.
(6) . All patients should have supportive
measures as indicated.
Some Unusual Aspects of Tularemia as Found in Mississippi*
L. R. MURPHREE
Aberdeen, Miss.
Tularemia, otherwise known as deer fly
fever, rabbit fever, or as Francis disease, is
an acute infectious disease found primarily
in animals but transmissible to man, which is
caused by the Pasteurella tularensis. It is
characterized by the development of a primary
ulcer and by the formation of the tubercle-like
necrotic foci in the lungs, liver, spleen and
lymph nodes.
We find records of this disease as seen in
market men dating back almost forty years,
for in 1907 Martin in a personal letter report-
ed five cases. The first published reports
were by Pearse, in 1911, who called the condi-
tion deer fly disease. The causative agent
Pasteurella tularensis was isolated and de-
scribed by two public health workers, McCoy
and Chaplin, who in California in 1912 in
Tulare County made the discovery and called
the disease tularemia from the county in which
the discovery was made in squirrels. Wherry
and Vail described the condition in man. Fran-
cis then in 1919 put all this together and
described the condition found in the lower
animals and transmitted to man.
As said above, tularemia is primarily a dis-
ease of lower animals, chief among which is
the rabbit and included are the sheep, coyote,
cats, quail and squirrel. Insect vectors are
commonly the deer fly, ticks, fleas, lice and
the horse fly. Horses, cattle, dogs and chick-
ens are immune. Cases have been reported
from ingestion of contaminated water supply,
as well as inhalation of droplets, air borne as
in the laboratory. Man to man infection is
rare.
Until 1915 only fifteen cases had been re-
ported in the nation. Due to better recogni-
tion of the disease and to its spread, by 1932
there were reported 1502 cases with forty-one
deaths in the nation. In 1925 the disease was
reported in Japan. More than a thousand
cases were reported in Russia in 1929 due to
floods there that year. Few cases were re-
ported in Mississippi prior to 1940 at which
time seven cases with five deaths were re-
ported. 1941 saw forty cases with two deaths,
1942 fifty cases with five deaths, 1943 with
sixty-five cases and three deaths, while in
1944 eighty-three cases were reported. The
January, 1946
Tularemia — Murphree
535
majority of these cases gave a history of
handling rabbits while a few gave a history
of having been bitten by the tick. The season-
al incidence of this disease coincides with the
rabbit season, so to speak, or in December and
January.
The pathology of this condition is the typi-
cal ulcer which is found at the site of infection
and the areas of focal necrosis in the lymph
nodes, spleen, liver and lungs. The lesions in
man are granulomatous in nature and identi-
cal with those in animals. The liver and the
spleen are enlarged and studded with discrete
or confluent, pinhead-sized, white spots, tuber-
cles. The presence of numerous grayish white
flecks in the liver and spleen is suggestive
of miliary tuberculosis. The cut surfaces
show similar changes ; the centers of the larger
nodules are necrotic and depressed. In some
cases one or the other organ may be free
from the macroscopic nodules. Similar changes
are often found in the various lymph nodes
especially those draining the primary site.
Histologically submiliary areas of focal necro-
sis are found similar to the macroscopic
lesions. They are composed of collections of
epithelioid cells, proliferated reticulo-endothel-
ial cells and multinucleated cells. Typical
giant cells of the Langerhans type are rarely
found, karyorrhexis and necrosis are found in
the center of the nodules. Pasteurella tularen-
sis in clumps and in vast numbers can often
be demonstrated in animal tissue but with
difficulty in human tissue. The organisms are
found both intracellularly and extracellularly.
The primary ulcer shows unspecific diffuse
necrosis, nuclear fragmentation and polymor-
phonuclear cell infiltration. Lymphangitis and
suppuration of the regional lymphatics and
lymph nodes may occur. The lungs frequent-
ly contain nodules of focal necrosis or patches
of pneumonia characterized by a monocytic
infiltration and exudation. The tracheobronch-
ial lymph nodes are frequently enlarged. Gen-
eral peritonitis, pleurisy with effusion, ulcera-
tions in the caecum, meningitis and encephalitis
have been observed.
Clinically there is usually described four
general types, namely the ulceroglandular, the
oculoglandular, glandular and the typhoid
types. The most common type is the first
named and is characterized by first pain in
the region of the regional nodes with chills,
fever, headache and general prostration. This
is followed by definite enlargement of the
regional nodes and the formation of a papule
at the primary site of infection. This papule
rapidly ‘breaks down and later heals by filling
in with scar tissue. The glands may go on
to suppuration or may remain firm and hard
for several months and completely disappear.
There is an associated lymphangitis and oc-
casionally there may be some nodulations
along the lymphatics which will simulate
sporotrichoses. Weakness and loss of weight,
recurring_chills, sweats and prostration are
often noted during the active stage of dis-
ease lasting from two to three weeks. The
oculo-glandular follows the above course ex-
cept for the primary lesion being in the con-
junctival sac either unilateral or bilateral with
involvement of the post-auricular and the
cervical nodes. The typhoid type is charac-
terized only by fever and prostration and the
diagnosis is made only by the agglutinations.
The temperature curve is rather significant
in that there is an initial rise lasting a day
or two with its return to normal. This is
followed in a day or two by the secondary rise
with this remaining constant for two or three
weeks. In certain patients evidence of bron-
chitis and pneumonia is manifested by pain in
the chest, cough and bloody sputum. The
symptoms of pneumonia may dominate the
picture and obscure the diagnosis unless care-
ful studies are made, for the pneumonia is of
the atypical form. Specific meningitis and
peritonitis do occur. Severe shifting joint
pains with some skin eruptions can occasion-
ally be seen. Vomiting, abdominal pains and
tachycardia can be seen. According to Willis
signs of pneumonia offer a poor prognosis and
this has been the case in my experience.
Diagnosis is made from the clinical picture
above with the history generally of the con-
tact with infected animals or insects with the
positive agglutinations. The State Board of
Health, by doing these agglutinations routine-
ly, has done a lot toward making the diagnoses
in many cases. It is interesting to note that
there are cross-agglutinations with the brucel-
la abortus and melitensis. There is mild to
no leucocytosis with the count of twelve to
sixteen thousand being the rule.
Treatment is as a rule symptomatic. Specific
therapy with 10 cc of a 1:1000 aqueous solu-
tion of metaphen has been suggested. The
use of specific serum prepared by Fosay has
been suggested but not proved effective. The
sulfa group is ineffective as are the arsenicals.
Penicillin has proved ineffective in this condi-
536
Tularemia — IMurphree
January, 1946
tion. Surgical excision or incision of affected
nodes is advised only after marked fluctuation
is noted. The primary site will heal spontane-
ously.
The purpose of this paper is to review the
literature on the subject and to report three
cases which were unusual in that they were
rather difficult in their diagnosis.
Case One. This was a colored male who
entered the hospital with the complaint of
sore mouth and throat and high fever, which
had been present for one week. For three
days he had been unable to take nourishment.
Physical examination revealed a dehydrated
colored male of 24 years of age with tempera-
ture of 103° on admission. Examination was
negative except for the large hypertrophied
tonsils with a granulating mass on one. Blood
count and urinalysis were noncontributory.
Agglutinations for tularemia were positive in
dilutions of 1:1280. He was given intravenous
fluids, blood transfusions, neoarsphenamine,
and sulfadiazine and seemed better until the
tenth hospital day when he developed some
pleural effusion and an atypical pneumonia
and became rapidly worse and expired.
Case Two. This was a colored female aged
sixteen who was seen and treated in the home
due to crowded conditions in hospital. She
had a chief complaint of fever, pain in abdo-
men, and diarrhea. Physical examination
showed well developed girl of sixteen with a
temperature of 106° who was quite irrational.
Her tonsils were hypertrophied but not in-
flamed. Chest was normal. Abdomen show-
ed generalized tenderness. Diagnosis of ty-
phoid fever made but blood and stools and
urine were negative. The second week of
illness the tonsils became inflamed and the
temperature continued to spike to 105° daily.
Repeat agglutinations in the third week of
illness showed a positive agglutination of
1:10,240. Fever gradually declined till in
fifth week when it became normal. X-ray
in fourth week showed an area of pneumonitis
in right upper lobe. Eight weeks after onset
patient was almost normal again except for
generalized weakness. Therapy in this case
consisted only of aspirin and increased vita-
min intake.
Case Three. This was a white female of 23
years with a chief complaint of mass in neck
and sore throat, of three weeks' duration.
There was some fever at the onset but patient
did not feel ill and did not stop her regular
activities. Physical examination revealed a
well developed white female with only the en-
larged angular node and the hypertrophied
tonsils. There was no response to the sulfa
therapy and agglutinations were positive 1:640
for tularemia. Nodes returned to normal in
three to four months.
The history in all of the above cases was
absolutely negative for contact with rabbits,
ticks, squirrels or flies. There had been no
initial lesions at all. In fact there was noth-
ing in their histories suggesting contact with
any infected animals.
Conclusions. The current literature regard-
ing diagnosis, symptoms, and treatment of
tularemia is reviewed. Three cases are re-
ported which were a bit unusual in that all
showed hypertrophy of tonsils, all gave no
history of contact with an infected animal.
Two were unusually severe and one was fatal.
BIBLIOGRAPHY
Simpson, W. M. Tularemia, November, 1929.
Little, R. D. Pathology of Tularemia; Nat- Inst.
Health Bub 1937.
Blackford, S. S- Pulmonary Manifestations of Tu-
laremia, J. A. M. A. 1935 104-89.
Byfield — Tick-Borne Tularemia, J. A. M. A. 11-27,
1945.
Musser, J. H. Textbook of Medicine.
Poshay, L; Summary of Certain Aspects of Tular-
emia including1 Methods of Diagnosis.
Prances, E; Source of Infection and Seasonal In-
cidence of Tularemia.
No Place for Him
A young lawyer from the North sought
to locate in the South. He wrote to a friend
in Alabama, asking him what the prospects
seemed to be in the city for “an honest young
lawyer and Republican.’’
In reply the friend wrote: “If you are an
honest lawyer, you will have little competi-
tion. If you are a Republican, the game laws
will protect you.”
Cancer*
WILLARD H. PARSONS, M.D .**
Vicksburg, Mississippi
Grim evidence of the importance of
this subject is offered by the fact that
165,000 individuals in the United States
have died, or will die, of cancer during the
year 1945. During the preceding year in the
state of Mississippi 1570 persons died of this
disease.
During the six-month period of this from
June 1, 1945, to November 30, 1945, there
were examined in the laboratories of pathology
of the Vicksburg Hospital, Inc., (exclusive of
necropsy tissues) a total number of 1624 tis-
sues and of this number 115 represented ma-
lignancies. Of this group of malignancies 55
involved the skin, the breast, the external
genitalia or the cervix uteri. In all of this
group the lesions from their very inception
were subject to inspection, to palpation and to
the performance of biopsy and presumably
therefore in each instance the correct diagnosis
could have been made sufficiently early almost
to have guaranteed cure if treatment by ap-
propriate means were provided.
Of the remaining group of malignancies
seen at this hospital during the period of time
referred to a considerable number involved
the gastriointestinal tract. There are few lo-
cations in the body that a neoplasm if present
* Written at request of the Mississippi Division of
The American Cancer Society.
**From the Departments of Pathology and Surgery
of the Vicksburg- Hospital, Inc-, and The Vicksburg
Clinic.
cannot be demonstrated reasonably early in
its course by physical examination and roent-
genologic study. It is true that the examina-
tions must be properly conducted and the
roentgenologic studies must be made by one
adequately trained and experienced in the
field of roentgenology.
It is apparent that the tragedy of cancer
is not that it cannot be diagnosed but that it
is not diagnosed. The tragedy of cancer is not
that it cannot be cured but that it is not diag-
nosed sufficiently early to be cured. Unless
and until general practitioners recognize the
importance of eliciting a thorough history and
of making a complete physical examination,
and until clinicians insist upon a proper roent-
genologic study the diagnosis of - Gancer will
continue to be made late if at all. Until the
indication for, the technic of, and the enor-
mous value from biopsies is appreciated, posi-
tive early diagnoses will not be established and
patients having early and easily curable lesions
will be cured with great hazard if at all.
Unless and until the above considerations
are met a very high incidence of patients
coming to surgeons and to roentgenologists
for treatment will be found at the time they
are first seen by these individuals to carry al-
ready in their hands the candle of death; to
have set upon their foreheads the seal of
dissolution. At no time is the responsibility
of attending physicians greater than in the
care of patients having or suspected of having
neoplasms.
*****
There is no good in arguing with the ine-
vitable. The only argument available with an
east wind is to put on your overcoat.
— James Russel Lowell
*****
A modesty in expressing our sentiments
leaves us a liberty of changing them without
blushing.
— Bishop Thomas Wilson
537
538
Editorials
January, 1946
The Mississippi Doctor
Published monthly at Booneville, Mississippi.
Entered as second-class matter, January 19, 1928,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
W. H. ANDERSON, M.D. Editor-in-Chief
MILDRED P- ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
C. H. Lutterloh, M. D. President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D. Vice-President
Greenville, Miss.
John A. Moore, M- D Vice-President
El Dorado, Ark.
A. F. Cooper, M- D. Secretary-Treasurer
Memphis, Tenn.
Gilbert J. Levy, M- D Director of Exhibits
Memphis, Tenn.
E. M. Holder, M. D. C. R. Crutchfield, M. D.
F. M. Acree, M. D. H. King Wade, M. D.
Lawrence W. Long, M-D.
J G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life Building,
Jackson, Mississippi,
The function of a hospital is not to treat
people, but to furnish a place for doctors to
treat them.
§
What would it profit a state to multiply its
hospitals and their capacities and then have
not the doctors to staff them?
§
Why should our government not send the
returned soldier to the local hospital and have
him treated and pay for it as has been done
for many of the wives of soldiers ?
Every practitioner should have in his of-
fice a trained nurse. It is not that a doctor
does not know oftentimes, but that a nurse
can increase his efficiency. She can help him
examine people, help him treat them, help him
practice preventive medicine by education, help
him along the way of financial success, and
help him uncover the diamonds of service in
his office from the dust and under the rust.
In terms of medicine a nurse can help him
to serve cornbread as if it were pound cake,
that is, if she has the brain to think, the will
to work, and some of the spirit of Florence
Nightingale.
§
Mississippi has a fine distribution of hos*-
pitals. This is very important. Each county
should have hospital facilities sufficient to
take care of its -sick, either in its own county
or an adjoining county. A big district hospital
is too expensive. When people have to travel
even fifty miles to a hospital the total expense
to the patient is too much when all cost is
counted. It is just the same economy as to
require all the people in the county to go to
the county seat for their mail instead of hav-
ing just a few to deliver it to them.
§
Jackson is the crossroads of the deep South
and the fastest growing city within its con-
fines. It now has a population of more than
seventy-five thousand, which within just a few
years will be doubled. A four-year medical
school with the last two years located in Jack-
son, would augment further the usefulness of
this hospital, which in turn would supply
clinical material.
§
The morale of the nurses and the attend-
ants ,at a hospital, the good atmosphere they
create, inspires the patient to live and makes
good business for the hospital also.
§
FOUR-YEAR MEDICAL SCHOOL
The chief claims of the opposition to the
four-year medical school are that we have no
town in Mississippi large enough to furnish
clinical material for the last two years. On in-
vestigation it has been found that some of our
very best medical schools are in towns much
smaller than Jackson, about ten out of the
nation’s total of sixty-eight schools. The Uni-
versity of Iowa at Iowa City, one of the na-
tion’s best medical schools, is in a town which
has a population of 17,182. Charlotte, where
the University of Virginia is located, has only
19,400. The University of Michigan, which is
most outstanding, is located in Ann Arbor, a
city of only 29,000.
The opposition also claim that having a
school in our state will not give us any more
doctors, but Tennessee, Arkansas, and Louisi-
January, 1946
539
ana average one doctor to every one thous-
and population, while Mississippi has one to
twenty-five hundred. These states have medi-
cal schools, two in Louisiana.
The opposition aver that we should first
spend millions of dollars on hospitals. Multi-
plied hospitals without properly trained doctors
to staff them would be a waste of founds
and very dangerous to the people. The train-
ing of doctors and the further development of
hospitals should go hand in hand.
The opposition say that Mississippi is not
able to add two years to the two years it al-
ready supports. When this two-year school
was organized, and it has been one of the best
in the nation, we were plowing with a bull ton-
gue plow on a Georgia iron-foot plow stock with
a small mule, one man working maybe ten
acres; today in the rich Delta by machinery
one man is working and gathering one hundred
acres. Our state now stands first in an arter-
ial system of concrete roads, second in cotton
production, third in timber, tenth in oil, has the
biggest pecan industry in the nation, the best
health department, one of the best hospitals
for tuberculosis, a good medical journal and
stands at the very top in democratic leader-
ship for the nation. With these progressive
facts before us it is an insult to our fine boys
to say that we must farm them out with other
schools for the last two years in medicine.
Our population is increasing by leaps and
bounds. The nation must add a number of
schools or enlarge the ones it has. If every
other Southern state can have from one to
three schools, surely we are not so lacking in
vision nor so niggardly at heart to contend
that our state continue to work on the halves,
medically speaking.
Mississippi should have an affiliated hospi-
tal system whose chief purpose should be to
serve the people and at the same time to train
nurses and interns, part time in the small hos-
pital and part time in the large. Consultation
service should be carried out to the practition-
er and his patients in the community hospitals.
Our hospitals should be open so as to secure
the benefits of the Blue Cross insurance. The
bill both for hospital and doctor must be paid
by the government for the very low income
group.
Mississippi has a great opportunity to show
the way around state medicine. The responsi-
bility right now is upon our legislature. But
if the doctors of the state will assert them-
selves and show that they have the vision of
medical service to the people we will at this
session of our lawmakers have a four-year
medical school established.
§
FROM DR. BRYAN
Dear Dr. Anderson:
I have accepted my invalidism in the most
philosophic way possible to me and I am
living, largely, in retrospect. During the more
than half century that I have practiced medi-
cine, I have met, known, and loved a great
many doctors. Not one of these have I ever
regarded as a rival or competitor, but rather
as a partner and coworker in a great under-
taking. A suggested thought has caused me
to undertake something which will, if success-
ful, be the crowning effort of a long and ill-
spent life. It is this: I am asking each reader
of your journal, whether he resides in Missis-
sippi or beyond her borders, to send me his
or her photograph accompanied by a very brief
biographical sketch — name, address, date of
birth, marriage, date and school of graduation,
etc. These I promise to arrange, preserve
and handle with care and reverence. This col-
lection I will regard as my mental garden of
roses. It will be my great delight to take
frequent strolls through its lanes and avenues.
I will, also, take great pleasure in showing it
to any and all who may be interested in it.
This collection, I think, will increase in value
after both those pictured and I have passed
on. I am asking you to carry this communica-
tion in the columns of your journal and to call
editorial attention to it.
Yours sincerely,
G. S. BRYAN,
Amory, Mississippi
News and Comment
SOUTHEASTERN SURGICAL CONGRESS
For the first time in its history, the South-
eastern Surgical Congress, which has a mem-
bership of 600, will meet in Memphis March
11 through March 13 at the Peabody Hotel.
The Congress which last met in 1942, will
be attended by doctors from Tennessee, Ken-
tucky, Virginia, North Carolina, South Caro-
lina, Florida, Georgia, Alabama, Mississippi,
Louisiana, and West Virginia.
Dr. Alton Oschner, professor of surgery at
540
January, 1946
Tulane University, New Orleans, is president
of the group, and Dr. B. T. Beasley of Atlanta
is secretary general. Dr. R. L. Sanders of
Memphis is general chairman of the meeting.
Committee chairmen are as follows:
Auditorium and Commercial Exhibits Com-
mittee— Dr. Arthur R. Porter, Jr. ; Clinic Com-
mittee— Dr. C. Harold Avent; Entertainment
Committee — Dr. Thomas D. Moore; Hotel Com-
mittee— Dr. Ernest G. Kelley; Publicity Com-
mittee— Dr. H. K. Turley; Reception Com-
mittee— Dr. Morton J. Tendler; Transportation
Committee — Dr. Joseph H. Frances; Ladies’
Entertainment Committee — Mrs. Jewell M.
Dorris, chairman; Mrs. Michael W. Holehan,
co chairman.
The following are a partial list of those
who will take part on the program:
Dr. Conrad G. Collins, New Orleans; Dr.
Merrill N. Foote, Brooklyn; Dr. Clarence E.
Gardner, Durham; Dr. James E. Hemphill,
Charlotte; Dr. Robert Hingson, Jr., Staten Is-
land; Dr. Arnold Jackson, Madison, Wis. ;
Dr. Roy R. Kracke, Birmingham; Dr. Karl A.
Meyer, Chicago; Dr. J. O. Morgan, Gadsden,
Ala.; Dr. Curtice Rosser, Dallis; Dr. Harold
E. Simon, Birmingham; Dr. G. L. Simpson,
Greenville, Ky. ; Dr. Horace G. Smithy,
Charleston, S. C.
The medical profession is invited to at-
tend the assembly. For information write Dr.
B. T. Beasley, secretary-manager, Atlanta 3,
Ga.
ANNOUNCEMENT
Dr. Henry G. Hill announces that arrange-
ments have been made with Dr. William T.
Howard to open permanently his offices at
the Henry G. Hill Clinic, 847 Madison, Ave.,
Memphis Tennessee, practice limited to ortho-
pedic and traumatic surgery.
NEW PUBLICATION
Announcement of a new publication the
Quarterly Review of Pediatrics , is lotf interest
to the profession. The prime function of this
little journal, which appears the first time in
February, is to make it feasible for the busy
physician to keep abreast of the most recent
progress in all branches of pediatrics with a
minimum of time and effort. The Quarterly
Review of Pediatrics serves also as an authori-
tative guide to original sources when more de-
tailed information is desired.
Address communications to Irving J. Wol-
man, M.D., Editor-in-Chief, The Children’s
Hospital, 1740 Bainbridge Street, Philadelphia
46, Pa.
THE NEW ORLEANS GRADUATE
MEDICAL ASSEMBLY
The New Orleans Graduate Medical Assem-
bly, ninth annual meeting, will be held in New
Orleans April 1-4, at the Municipal Auditorium.
The program will consist of lectures by six-
teen outstanding guest speakers, clinics, sym-
posia, clinico-pathologic conferences, round-
table luncheon discussions and technical ex-
hibits. Registration fee of $10.00 covers all
features, including three luncheons. Physicians
who plan to attend are invited to register at
once with the Secretary, Room 105, 1430
Tulane Avenue, New Orleans 13, Louisiana.
Information regarding hotel reservations will
be sent upon receipt of registration fee or by
request.
MEDICAL GROUP ELECTS
Paris, Tenn., Jan. 13. — Dr. Henriette Velt-
man has been elected president of the Henry
County Medical Society for 1946 to succeed
Dr. Elroy Scruggs. Other officers include Dr.
W. G. Rhea, vice president; Dr. R. G. Fish,
secretary. Dr. R. J. Perry of Maryville was
chosen delegate to the state medical meeting.
Dr. Fish was elected alternate.
NEW INSTRUMENT
American Optical Company announces it is
making available to the profession the new
Root nearpoint tachistoscope, latest instrument
for improving visual preception by exposing
figures and other visual stimuli at near point
for fractions of a second.
CONDITIONS GOVERNING
POSTGRADUATE FELLOWSHIPS
Offered by the Commonwealth Fund to
General Practitioners
Fellowship aid shall be limited to honor-
ably discharged physicians who have seen ser-
vice for six months or longer, since 1940, in
the armed forces of the United States, and who
plan to take up residence and to practice in a
community having a population of 25,000 or
January, 1946
541
less, situated in Mississippi, OkUnoma, or
Tennessee.
The Fund shall assume no responsibility for
the registration of a fellow in a particular
course; this arrangement must be made by
the individual with the institution where the
work is offered. Courses shall be taken in a
continuous term and shall not depart from
the approved schedule without special authori-
zation.
The applicant shall be a graduate of a repu-
table medical school and have completed a
satisfactory internship. He shall furnish a
record of a recent physical examination, and
a personal interview with a member of the
Fund staff may be required.
The rate of the fellowship shall be uniform
at $100 a month for the duration of the
award, one to four months. Application for
fellowship shall be made on forms furnished
by THE COMMONWEALTH FUND, Division
of Public Health, 41 East 57th Street, New
York 22, N. Y.
Physicians who qualify may be considered
for a fellowship which provides postgraduate
study for one to four months at an approved
institution. The course or courses of study
shall be subject to approval by the Fund and
may include general medicine and diagnosis,
pediatrics, obstetrics, medical gynecology, or
minor surgery, or combinations of two or more
of these subjects.
MISSISSIPPI ONCE HAD A FOUR-YEAR
SCHOOL
Once during the twentieth century, Missis-
sippi had a four-year medical school located
at Meridian. After a number of years of suc-
cessful operation, it was closed in 1911, when
the legislature failed to provide funds for its
maintenance.
Today twenty-five of the graduates of the
school are living and practicing medicine in
the state.
In a bulletin printed in 1909 by the school
(page 8, Mississippi Medical College Catalog)
the following statement is made: “The large
number of medical students who in the past
have been forced to leave their home state in
quest of a medical education, and the many
young Mississippians, men and women, who
are already engaged in the study of medicine
and surgery and who contemplate doing so
are unanswerable evidence of the imperative
need for a school of medicine in the state, with
a full curriculum, where all the branches of
the healing art can be taught and demonstrat-
ed.”
It is believed that if the medical school
had been continued and had hospitals and
clinics been established where physicians could
work, the state today would not be facing a
shortage of physicians.
Of the graduates listed in the 1909 catalog
of the medical school 66 per cent practiced
in Mississippi, that is, ten out of fifteen who
graduated. The five who did not practice in
Mississippi practiced in Alabama, Tennessee,
and Florida.
The following Mississippi physicians attend-
ed and/or graduated from the medical school
at Meridian; Dr. J. B. Ainsworth, Raymond;
Dr. T. C. Alford, Mashulaville ; Dr. E. E. Busby,
Brookhaven; Dr. D. J. Dubose, Purvis; Dr.
W. D. Franklin, Walnut Grove; Dr. J. S. Hick-
man, Meridian; Dr. L. W. Hood, Biloxi; Dr.
J. W. Horn, Lucedale; Dr. W. W. Irby, Merid-
ian; Dr. E. Lovorn, Louisville; Dr. D. W. Mc-
Donald, Meridian; Dr. S. S. Mcllwain, Pas-
cagoula; Dr. S. T. Mcllwain, Waynesboro; Dr.
R. R. McNease, Sumrall; Dr. G. M. Martin,
Stonewall; Dr. T. C. Oliver, Leland; Dr. A.
Potasnic, Meridian; Dr. P. C. Risher, Laurel;
Dr. E. R. iShurley, Money; Dr. J. F. Simmons,
Greenville; Dr. H. P. Smith, New Augusta;
Dr. H. H. Tabor, Weir; Dr. H. A. Thigpen,
Bay Springs; Dr. L. W. Walker, Auburn; and
Dr. R. M. Webb, Canton. Several other phy-
sicians received a year or more of their medi-
cal education at the Mississippi Medical Col-
lege.
Since the closure of the medical college, no
provision has been made for graduation of
medical students in the state. Students must
still leave the state to complete their medical
education and serve internship.
PHYSICIANS RETURNED FROM
MILITARY SERVICE
Dr. F. M. Acree, Greenville
Dr. A. L. Adam, Poplarville
Dr. A. H. Applewhite, Columbia
Dr. J. A. Atkinson, Brookhaven
Dr. J. W. Austin, Forest
Dr. T. A. Baines, Jackson
Dr. D. Baugh, Columbus
Dr. O. H. Beck, Greenville
542
January, 1946
Dr. M. D. Berman, Jackson
Dr. G. L. Biles, Sumner
Dr. L. B. Brackstone, Corinth
Dr. E. V. Bramlett, Oxford
Dr. R. H. Brumfield, McComb
Dr. G. A. Campbell, West Point
Dr. V. J. Canizaro, Biloxi
Dr. W. L. Chambers, Pickens
Dr. H. L. Cockerham, Jr., Shelby
Dr. J. E. Coe, Leland
Dr. W. H. Cook, Meridian
Dr. W. W. Crawford, Tylertown
Dr. E. W. Crocker, Calhoun City
Dr. H. K. Curry, Eupora
Dr. R. T. Dabbs, Aberdeen
Dr. W. M. Dabney, Amory
Dr. J. T. Davis, Corinth
Dr. J. G. Dees, Jackson
Dr. R. H. DeJarnette, Corinth
Dr. R. L. Donald, Meridian
Dr. C. F. Dorsey, Brookhaven
Dr. H. C. Dorris, Winona
Dr. T. S. Eddleman, Jackson
Dr. J. S. Edmondson, Vardaman
Dr. E. T. Ellison, Greenville
Dr. Roscoe Faulkner, Batesville
Dr. L. C. Feemster, Jr., Tupelo
Dr. J. H. Fox, Jackson
Dr. C. L. Gaston, Jr., Meridian
Dr. H. B. Goodman, Cary
Dr. Donald S. Hall, Vicksburg
Dr. James L. Hall, Vicksburg
Dr. F. J. Harrell, Jr., Biloxi
Dr. Andrew Hedmeg, Pascagoula
Dr. B. R. Heninger, Gulfport
Dr. J. R. Hightower, Itta Bena
Dr. J. A. Hull, Indianola
Dr. R. L. Holley, Jr., Oxford
Dr. F. D. Hollo well, Jr., Jackson
Dr. H. L. Howard, Winona
Dr. R. P. Hudson, Utica
Dr. L. B. Hudson, Hattiesburg
Dr. A. D. Hurt, Corinth
Dr. Nathan F. Kendall, Jackson
Dr. C. R. Jenkins, Laurel
Dr. W. N. Jenkins, Port Gibson
Dr. J. R. Johnson, Jackson
Dr. W. C. Jones, Macon
Dr. J. J. Kazar, Tchula
Dr. C. F. Lacey, Thomastown
Dr. E. L. Laird, Union
Dr. A. R. Lee, Tylertown
Dr. J. H. Leigh, Lexington
Dr. J. L. Levy, Clarksdale
Dr. C. J. Lewis, Meridian
Dr. N. B. Lewis, Vicksburg
Dr. C. M. Lobrano, Vicksburg
Dr. J. R. Markette, Brookhaven
Dr. R. C. Massengill, Brookhaven
Dr. F. C. Massengill, Brookhaven
Dr. G. S. Mason, Lumberton
Dr. E. A. Melvin, Gulfport
Dr. C. B. Mitchell, Whitfield
Dr. D. H. Moore, Meridian
Dr. J. A. Murfee, Amory
Dr. L. L. McCharen, West Point
Dr. J. E. McDill, Jackson
Dr. S. S. McNair, Jackson
Dr. W. W. Nobles, Tunica
Dr. W. E. Noblin, Jr., Jackson
Dr. P. H. Parker, Meridian
Dr. J. G. Peeler, Shaw
Dr. C. D. Pritchard, Marks
Dr. Thomas Purser, Jr., McComb
Dr. R. B. Ray, Kosciusko
Dr. E. D. Reynolds, Clinton
Dr. O. E. Ringold, Cleveland
Dr. M. H. Robertson, Corinth
Dr. T. E. Ross, Hattiesburg
Dr. H. K. Rouse, Jr., Gulfport
Dr. G. A. Rush, Jr., Meridian
Dr. E. W. Ryan, Charleston
Dr. F. M. Sandifer, Greenwood
Dr. J. H. Scott, Carthage
Dr. W. P. Sheely, Gulfport
Dr. W. H. Simmons, Jr., Jackson
Dr. F. M. B. Slater, Jackson
Dr. R. W. Smith, Canton
Dr. M. M. Snelling, Gulfport
Dr. W. L. Stallworth, Columbus
Dr. R. A. Street, Jr., Vicksburg
Dr. C. Thompson, Jr., Columbia
Dr. E. A. Thorne, Holly Springs
Dr. H. M. Wadsworth, Hernando
Dr. B. N. Walker, Jr., Jackson
Dr. C. E. Ward, Jackson
Dr. R. B. Warriner, Jr., Corinth
Dr. W. J. Weatherford, Pascagoula
Dr. J. A. Westerfield, Merigold
Dr. H. A. Whittington, Natchez
Dr. H. M. Williams, Aberdeen
Dr. T. R. Williams, Tchula
Dr. J. K. Wilson, Hollandale
Dr. W. S. Witte, Leland
Dr. Edwin H. West, Lucedale
Dr. J. W. Williams, Ingomar
Dr. J. C. Wilson, Hollandale
Dr. T. E. Wilson, Jr., Jackson
Dr. J. G. Young, Holly Springs
Total — 118
January, 1946
543
Deaths
TULANE UNIVERSITY SCHOOL
OF MEDICINE
March 11-May 25, 1946
Review of General Medical Practice
March 18-23 — Disease of the Cardiovascular
System. March 25-30— Pulmonary Disease;
April 1-6 — No classes. April 8-13 — Urinary Dis-
ease. April 15-20 — Disease of the Nervous
System. April 22-27 — Nutritional and Meta-
bolic Disease. April 29-May 4 — Infectious Dis-
eases. May 6-11— Neoplastic Diseases. May
13-18 — Obstetrics and Gynecology. May 20-25
— Traumatology.
The courses will include both the medical
and surgical approach, anatomy and physiology
will be reviewed, and usually there will be one
prominent guest speaker.
Application for all or any of the one-week
courses should be made directly to:
Dr. H. W. Kostmayer, Director
Tulane University School of Medicine
New Orleans, Louisiana
The tuition of $25 a week may be met
under the G. I. Bill by securing a certificate
of eligibility from Mr. J. L. Easom, Veteran’s
Administration, Jackson 107, Mississippi, us-
ing the Rehabilitation Form 1950. No scholar-
ships are available at the present time through
the Mississippi State Board of Health.
ANNOUNCEMENT
DR. THOMAS E. WILSON
announces
his return to private practice
INTERNAL MEDICINE
and
CARDIOLOGY
Medical Clinic Bldg.
910 North State .Street, Jackson, Miss.
Health foundations for health centers should
be the order of the day in our state, especi-
ally for the small town.
Deaths
DR. JOHN E. DAVIS
Funeral services for Dr. John E. Davis, 79, pro-
minent Columbus physician and surgeon died un-
expectedly at his home December 15. Dr. Davis
had been in ill health for some time.
Born in Crawford In 1866, he was the son of
James and Hester Agnes Hemphill Davis- A gradu-
ate of State College at Starkville, he received his
degree in medicine at Tulane University where he
was first honor man. He was sent by the state of
Louisiana to Honduras to make a study of yellow
fever-
Completing this work, he returned to Columbus to
practice and opened the Davis Infirmary. He later
built and operated the Columbus Hospital- A doctor
of “the old school,’’ to his patients he was more than
a physician — a family friend and counselor as well.
During this period he earned a national reputation
as a diagnostician.
He served with the Medical Corps in World War
I and was a survivor of the torpedoed ship Georgia,
when he was taken prisoner by the Germans. After
the war ended he returned to Columbus and resum-
ed his practice until ill health caused his retirement
in recent years, bringing to a close an outstanding-
medical career.
He is survived by his widow, Mrs. Vernon Waller
Davis; a sister, Mrs. Rupert Richards of Crawford;
two nieces, Mrs. B- T- Collier of Tuscaloosa and
Mrs- D. D. Stephenson of Birmingham ; two nephew-s,
S. J. Webb of Los Angeles, Calif., and James H.
Webb of Denver, Colo-
DR. LEWIS C. JONES
Funeral services for Dr- Lewis C. Jones, 84, of
Madison were held in Jackson, December 31, 1945,
from Wright and Fergerson funeral chapel.
Dr- Jones, a native of Brownsville, has been in
medical practice at Madison for more than fifty years-
He was a graduate of Louisville Medical College,
Louisville, Ky., in 1886.
DR. Y. E. GORDON
After an illness of several months Dr- Y. E. Gor-
don, prominent physician and citizen of Bucatunna,
died at the family home there in October- He was 85.
Dr. Gordon, who had practiced his profession in
Chicora and Bucatunna for the past half century,
is survived by his widow and the following children :
Jesse C- Gordon, of Bucatunna; Sampie, of Virginia;
Walter Gordon, Mrs. C. C- Thames and Mrs. San-
son, of Mobile. Brothers surviving: Eugene, of
Enterprise, and Mark of Pachuta.
DR. J. W. ECKFORD
Funeral services were conducted January 7 at
Starkville for Dr. James William Eckford, beloved
retired physician, who died in a hospital there. He
had been in ill health since his retirement three
years ago and had been in the hospital ten days.
Dr. Eckford practiced medicine in Starkville 47
years and it was estimated he delivered more than
3000 babies-
The services at the Methodist Church were con-
ducted by the Rev. Phil Grice and the Rev. J. D.
Ray.
Dr- Eckford leaves two sons. Dr. J. F. Eckford and
J. W. Eckford, Jr., of Starkville, and three daughters
Mrs. L S. Lundy, Front Royal, Va., Mrs. Beulah
McFarlane, Cleveland, Miss., and Mrs- William Jones
of Rio de Janeiro.
Born at Soule Chapel in Noxubee County, Dr.
Eckford was the son of Dr. J. W. and Fannie Lucas
Eckford. He attended public school in Macon and
the old Southern University in Greensboro, Ala. He
received his M. D. from Tulane in 1895 and moved to
Starkville a year later.
reting Medical Literature
•Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health Felix J. Underwood, Jackson.
Pediatrics Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery— W. H. Rarsons, Vicksburg.
Urology— Temple1 Ainsworth, Jackson.
pediatrics
Hepatic Damage: in Infantile Pellagra
Theodore Gillman, M.Sc., M.B., BCh. and Jo-
seph Gillman, M.B., B.Ch., Johannesburg,
South Africa.
The authors state that during the last three
years nearly 300 children suffering from acute
malnutrition have been admitted to the Non-
European Hospital, Johannesburg. More than
60 per cent of these infants manifested the
clinical signs of pellagra.
They have found in their experience that
vitamin therapy has not only failed to save
the lives of more than 50 per cent of these
children but in many instances they have
strongly suspected that it aggravated the dis-
ease and even hastened death. Trowell, promi-
nent worker in this field, has also recorded
the unresponsiveness of this disease to vitamin
therapy, including nicotinic acid. In these cir-
cumstances, therefore, it is essential to seek
some other method of saving the lives of chil-
dren suffering from severe malnutrition. The
authors give the following conclusion and
summary relative to this subject:
1. By means of liver biopsies we have
established that, on admission to the hos-
pital, the livers of infantile pellagrins show
various degrees of fatty change; in severe
cases almost every liver cell is distended
by a single globule of fat. Liver biopsy
is indispensable in establishing the prog-
nosis and in assessing the effectiveness of
any form of therapy. , :
2. The reactions of the liver to vitamins,
liver extract and dried stomach have been
studied in a selected series of 20 infantile
pellagrins with comparable hepatic lesions
on admission.
3. In severe cases the administration of
vitamins intensified the accumulation of
fat in the liver cells. Every one of the 7
cases treated with vitamins terminated
fatally.
4. Although liver extract rich in the Cohn
fraction is superior to vitamins, the fat
is depleted from the liver slowly despite
the clinical recovery. Only two of the
seven cases in this group ended fatally.
5. Dried stomach in 10 gm. doses daily
in combination with hydrochloric acid
leads to spectacular recovery of the pa-
tient and loss of edema fluid. Moreover,
the fat in the liver disappears rapidly and
almost completely in every instance. All
of the patients treated with dried stomach
recovered.
6. Although the fat content of the diet
is low, there is a massive accumulation of
fat in the liver, and it is excreted in large
amounts in the feces despite the emacia-
tion of the rest of the body. It is suggested
that, in infantile pellagra, carbohydrate is
converted into fat which cannot be util-
ized.
7. We conclude that the administration
of vitamins in severe nutritional edema as-
sociated with pellagrous lesions in infants
can be extremely dangerous and is con-
traindicated.
8. On the basis of the results obtained
in our carefully selected cases, dried
stomach is the most valuable therapeutic
agent available for the treatment of se-
vere infantile pellagra. Since dried stomach
causes the rapid depletion of fat from the
liver, it must be regarded as a vigorous
lipotrope.
9. In children discharged as clinically
cured, their biopsy has revealed the exist-
ence of residual liver damage, the extent
of which is determined by the severity of
the initial lesion and the nature of the
therapy.
10. Recurrent attacks of subclinical and
overt malnutrition result in progressive
544 v 1
January, 1946
Interpreting Medical Ljthiature
545
hepatic damage. These repeated insults are
in no small measure responsible for cir-
rhosis and probably for primary carcinoma
of the liver so frequently encountered in
young Negroes in South Africa.
COMMENT
We feel that the above article is quite in-
teresting and should be read and evaluated by
every practitioner of medicine not only in this
state but practically the southern states. It is
our opinion that along with many other dietary
deficiencies that the presence of pellagra in
children exists many more times than we have
formerly thought. We have seen many of these
cases which made us think very seriously about
the presence of this disease when least sus-
pected.
PUBLIC HEALTH
Hilleboe, H. E. — ‘‘The Responsibility of
the Private Physician in Tuberculosis Con-
trol.” Minnesota Medicine , viol. 28: 935, No-
vember, 1945.
The importance of the general practitioner
in the control of tuberculosis among private
patients is emphasized by the findings of the
Public Health Service in chest x-ray surveys
conducted among more than a million indus-
trial workers and by the discovery of a rela-
tively high incidence of the disease among
rejectees of the armed forces.
Eight mobile x-ray units, operated by the
Tuberculosis Control Division of the Public
Health Service in various parts of the coun-
try, found that three in every 200 persons ex-
amined had x-ray evidence of reinfection tu-
berculosis— active or inactive. Sixty-five per
cent of the lesions were in minimal stage, 30
per cent in moderately advanced stage and 5
per cent of the lesions in far-advanced stage.
Pre-induction examinations by Selective Ser-
vice alone revealed 150,000 cases with x-ray
evidence of tuberculosis.
That the family physician will be called
upon to treat a great majority of these persons
is borne out by the experience of the U. S.
Public Health Service and of the National Tu-
berculosis Association and its affiliates. In
industrial surveys an overwhelming number of
workers who could afford private care desig-
nated their family physicians — general prac-
titioners— as the doctors to whom the report
of the x-ray findings should be made. When
these reports are sent out they are accom-
panied by a request that the physician confirm
or disprove the x-ray findings by further clini-
cal studies — such as history and physical ex-
amination, laboratory tests and repeated x-ray
examinations. He is also asked to examine con-
tacts and to report the new cases of tuberculo-
sis to the local health department.
The average patient has a great deal of
confidence in his private physician and expects
him to treat tuberculosis just as he would ac-
cept other family medical emergencies. Psy-
chological factors make this desirable and
practical considerations make it feasible,
especially if the physician possesses sufficient-
ly broad understanding of tuberculosis and
modern therapeutic methods. Sanatorium care
is no longer the only method of tuberculosis
control. Many minimal lesions and a limited
number of inactive advanced lesions are amen-
able to outpatient supervision under strict
medical care. This supervision and care can
often be rendered by the alert general prac-
titioner who possesses modern knowledge of
the diagnosis and treatment of tuberculosis.
The demand for this type of care is expected
to increase rapidly as mass radiography units
penetrate all sections of the country, uncover-
ing a large number of unsuspected cases of
pulmonary tuberculosis that will need medical
supervision — before and after sanatorium care.
The personal experience of actually having
a chest x-ray will stimulate thousands of in-
dividuals to seek medical care, from general
practitioners, chest specialists and radiologists,
either for tuberculosis or for other chest con-
ditions found on survey examinations.
Through their vast nationwide educational
program, their case-finding and rehabilitation
work, which are supported by the sale of
Christmas Seals, the National Tuberculosis
Association and its affiliated groups will con-
tinue to awaken communities to the dangers
of the disease. As a result, communities will
provide the armamentarium needed for the
proper care of the tuberculosis patient — hos-
pital beds, clinics, laboratories, rehabilitation
service, extensive chest surveys and generous
social assistance for the dependents of the
tuberculosis patient.
The by-product of cooperative plans of pub-
lic agencies and voluntary associations will
provide new aids for the physician in private
practice — x-ray, laboratory and consultation
January, 194G
State Board of Health
of clinic, x-ray field services and laboratory
546
services, as well as opportunities for post-
graduate training. With these aids he will be
better equipped to meet the increasing de-
mands of the tuberculosis patient for his ser-
vices.
As x-ray surveys become an annual routine
in many communities, more and more minimal
lesions will be found, and, conversely, few-
er advanced lesions, which now, in most cases,
require immediate sanatorium care. The re-
versal of the old ratio will shorten and simpli-
fy therapy for the larger proportion of tu-
berculous patients, will assure quicker and
more complete treatment, and greatly increase
the chance of vocational rehabilitation.
A better distribution and greater expansion
facilities will bring modern diagnostic aids
within the reach of every general practitioner
in urban and rural areas. New, well-equipped
sanatoria, more accessible to population cen-
ters, and accredited for residency training, will
provide postgraduate training of great value
to the general practitioner. Research labora-
tories and demonstrations devoted to the e-
valuation of old and new therapeutic methods
and clinical concepts about tuberculosis have
already been established and will be increased
in number. From these efforts it is hoped ad-
ditional aids will be forthcoming for the phy-
sician, not only to control but to eradicate
the White Plague within a measurable time.
State Board of Health
Felix J* Underwood, M .D.
, .
PROTEIN IN THE DIET
by
MARY iSTANSEL
Nutritionist
The value of protein in the diet has been
receiving considerable attention in current con-
tributions to medical literature as more and
more individuals report detailed accounts of
their observations and experiences.
Diets more adequate in protein are seen as
a fundamental need among all income groups
in Mississippi. Prevailing food shortages af-
fecting the supply of milk, lean meat and
eggs, which are excellent sources of protein,
are bound to have an adverse effect upon
the diet if long continued; hence every effort
should be made to increase the production of
these foods to meet the current need.
Protein is important in the diet, because:
1. Since protein is part of all body tissues
and most body fluids, it is essential for both
growth and maintenance.
2. It is necessary for building and maintain-
ing normal hemoglobin.
3. It is an essential part of hormones and
enzymes.
4. Increased protein is essential for the well
being of the expectant mother and her baby.
5. There is an increased demand for pro-
tein in illness. High protein intake to correct
any protein deficiency is important in edema,
shock, surgical conditions and infections.
6. Many of the substances associated with
resistance to infection within the body are
proteins.
7. Serum proteins regulate the osmotic
pressure relationships within the body.
8. Protein-rich foods are important for their
high content of vitamins and minerals as well
as protein.
9. An excellent supply of protein helps pro-
tect the liver from damage from such toxic-
agents as chloroform and arsphenamine.
Some Foods That Supply Protein
Milk, 1 pt 16 gms.
Dried skim milk (2 oz.) 20 gms.
Lean meat, cooked (3| oz.) 25 gms.
Egg, one 6 gms.
Cheese, yellow (1 oz.) 7 gms.
Pinto beans, cooked (I cup) 10 gms.
Bread, 1 slice 3 gms.
Potato, (5 oz.) 3 gms.
Liver is the best lean meat one could choose
for his protein, with hog liver being higher
in food value than calf liver. Fish and poultry
are also excellent sources. Lean pork provides
liberal quantities of thiamine and need not be
taken from the diet during pregnancy, al-
January, 1946
. . 4, • • f V - - ..-*•#
State 'Board of Health
547
though salt fat pork and bacon, which count
as fat, should be limited due to the high salt
content.
Mississippi, long rich in agricultural re-
sources, seems to lag far behind in the pro-
duction of foods essential to the health and
welfare of its population. To correct this situa-
tion, the people themselves must first under-
stand and appreciate the value of adequate
nutrition. The physician, the public health
worker, and the schools have a real responsi-
bility in getting across to them the fundamen-
tals of this important science.
The Mississippi Public Health Association
held its ninth Annual Meeting in Jackson, De-
cember 10-12, with more than six hundred
members in attendance. Presided over by Dr.
C. M. Shipp, President, many timely and in-
teresting papers were presented in public
health and related topics. Guest speakers in-
cluded: Dr. C. C. Applewhite, New Orleans,
La.; Lieut. Col. Mary D. Forbes, Nurse Of-
ficer, Dist. 4, U.S.P.H.S., New Orleans; Dr.
Thomas L. Hagan, New Orleans; Miss Helen
M. Howell, Associate Professor of Public
Health Nursing, Vanderbilt University, Nash-
ville, Tenn. ; Dr. Edgar Hull, L.S.U. School of
Medicine, New Orleans; Mr. T. E. McNeel,
New Orleans; Dr. W. H. Y. Smith, Mont-
gomery, Ala.; Mr. H. C. Taylor, New Orleans,
La.; Dr. R. B. Turnbull, Gallatin, Tenn.; Dr.
Francis J. Weber, Washington, D. C. The
“President’s Night” featured an exceedingly
interesting address by the Honorable Carl
Marshall, to which the public was invited and
many attended.
Dr. A. L. Gray, Director of the Division of
Preventable Disease Control, succeeds Dr.
Shipp as President of the Association, and Dr.
H. B. Cottrell, Supervisor of the Field Unit.
Jackson, was reelected Secretary-Treasurer.
Mrs. Beatrice Butler, Jackson, for many years
with the Division of Public Health Nursing,
was made President-elect.
THE TULANE UNIVERSITY OF LOUISIANA
School of Medicine
New Orleans 13
Dear Dr. Underwood:
Returning veterans, as well as practitioners
in general, have frequently requested a rather
general review. Accordingly, we have finally
set up a review of General Medical Practice,
which I wish to describe .briefly.
Beginning March 11, 1946, we will give ten
weeks of instruction using both the medical
and surgical approach. Each week will be de-
voted to a special topic as listed below:
March 11-16 — Diseases of the Cardiovascu-
lar system. (A special evening course from 8
to 10 p.m., will be offered provided not less
than ten register).
March 18-23 — - Pulmonary Diseases.
March 25-30 — Gastrointestinal Diseases.
April 1-6— No Classes.
April 8-13 — Urinary Diseases.
April 15-20 — Diseases of the nervous sys-
tem.
April 22-27 — Nutritional and Metabolic Dis-
eases.
April 29-Ma.y 4 — Infectious Diseases.
May 6-11 — Neoplastic Diseases.
May 13-18 — Obstetrics and Gynecology.
May 20-25 — Traumatology.
In most instances physiology and anatomy
will be reviewed and usually there will be at
least one prominent guest speaker. The week
of April 1st, will be without classes as other
local postgraduate activities will provide ample
opportunities during that week. The fee will be
$25.00 per week and registrants may take as
many weeks as they see fit. The Veterans Ad-
ministration will approve this opportunity as
coming under the so-called G. I. Bill of Rights.
Sincerely yours,
H. W. Kostmayer, M.D.,
Director.
PREVALENCE OF COMMUNICABLE DISEASES
IN MISSISSIPPI
Nov.
Nov. Nov. Five-Yr-
1945
Acute Poliomyelitis . 11.
Bacillary Dysentery . 330
Dengue • 0
DSfphtheria . . - • • 120
Measles • • 202
Meningococcus Meningitis . . • • . .12
Other Forms Meningitis 2
Pneumonia •• ... .1179
Pulmonary Tuberculosis 148
Scarlet Fever . 126
Smallpox 5
Tularemia 2
Typhoid Fever 2
Typhus Fever •• 16
Undulant Fever 5
Whooping1 Cough 452
1945
Average
3
6-6
473
415-4
0
2
89
76.4
96
245.4
9
7.8
2
2.6
1051
1179.6
137
117.4
84
94-4
0
1.8
3
2.2
8
7.0
19
13-2
0
l.G
471
556.4
548
Woman’s Auxiliary
January, 1946
r Womans Auxiliary
President Mrs- L. J. Clark
Vicksburg-
President-Elect Mrs. Stanley Hill
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
FROM OUR PRESIDENT
Dear Auxiliary Members:
Greetings and every good wish for the new
year. Let us make an earnest effort to work
anew for our medical auxiliary, as important
work, imperative duties are awaiting us.
The second conference of the Woman’s
Auxiliary to the American Medical Associa-
tion was called to order by the president, Mrs.
David W. Thomas, the fifth of December at
nine o’clock.
The pledge of loyalty opened the meeting
and was most impressive as nearly forty
women repeated it in unison.
Everyone’s attention was directed to the
roll call by states, beginning with our neigh-
boring states of Alabama and Arkansas and
ending in the far west with Wyoming. Each
delegate stood as her state’s name was called.
Two delegates from Mississippi were present,
Mrs. Stanley Hill, your president-elect, and
your president. Our state has been honored
by the selection of a most capable director,
Mrs. V. B. Philpot, It was regretted that cir-
cumstances prevented her attendance at the
second Conference.
Dr. Malcolm T. McEachern, president-elect
of the Chicago Medical Society, spoke most
interestingly and brought greetings from his
society.
Minutes of the 1944 Conference were read
and approved. You were represented at that
meeting by your president-elect, Mrs. Stanley
Hill, your director from Mississippi on the
national board, Mrs. V. B. Philpot, and your
president.
Mrs. David W. Thomas gave a cordial ad-
dress of welcome, which was followed by the
election of the Conference chairman, Mrs. R.
E. Mosiman, of Seattle, Washington, who had
also served as chairman of the first one.
Mrs. Thomas gave an excellent report of the
progress and achievements of the auxiliary
during the very hard years of war.
Instructive and enlightening reports of com-
mittee chairmen were heard also. The reports
of the presidents and presidents-elect were
outstanding. Our state reports compared very
favorably with those of other states, except
in membership and benevolence.
Dr. Joseph Lawrence, executive director of
the Washington office, gave a talk upon the
big problem of political medicine facing the
medical profession. He urged the doctors’
wives to keep up community relationships.
Dr. W. W. Bauer, director of the Bureau
of Health Education of the A. M. A., was
introduced by our legislative chairman, Mrs.
Luther H. Kice. Dr. Bauer explained the
fourteen-point program adopted by the medi-
cal association and urged the delegates to in-
form themselves upon this program.
For the second time in the history of the
Medical Auxiliary a resolution was given to
the group by the House of Delegates of the
American Medical Association. The other res-
olution was on the promotion of Hygeia.
The second resolution is such an important
one I shall pass it on the you as given and
as follows:
Whereas, The object 'of the Woman’s Aux-
iliary is to aid the American Medical Associa-
tion in every way requested, and
Whereas, The most urgent need of the pres-
ent time is for widespread dissemination of
knowledge concerning the hazards of current
medical legislation, therefore
Be It Resolved , That the House of Delegates
of the American Medical Association requests
the Woman’s Auxiliary to use every avenue
possible to bring such information to its mem-
bers and through them the public.
What are we going to do? Are we going
to sit idly by and let the public get the wrong
information concerning current medical legis-
lation, lor shall we give the people the true
facts? I urge you as doctors’ wives to do
your part in this important work.
Cordially,
ANNE CLARK, president.
January, 1946
Woman’s Auxiliary
549
AUXILIARY MOTHER DIES AT LONG BEACH RESIDENCE
MRS. D. J. WILLIAMS
Mrs. Daniel J. Williams, 61, a resident of
the Mississippi Coast since 1912, died about
8:15 a. m. January 16 at her residence, Glen-
wood, on East Beach, Long Beach. She had
been in ill health for about two years.
Mrs. Williams, nee Maude Hepler, was born
in Washington, Ind., on March 16, 1883, the
daughter of Mr. and Mrs. Sam Hepler.
Dr. Williams, health officer at Port Gibson,
Miss., and formerly director of the Harrison
County health department, was at her bedside.
Mrs. Williams was a member of the Meth-
odist church. She was long active in civic and
community affairs and was a member of the
Gulfport Woman’s Club, serving as president
for several years. She was also a member of
the Long Beach Garden Club, Daughters of
the American Revolution, United Daughters of
the Confederacy, and the Coast Medical Aux-
iliary.
Mrs. Williams was presented a trophy on
April 10, 1939, in recognition for her out-
standing service to the community during
1938. Particular achievements mentioned in-
cluded her leadership in caring for the Gulf-
port Doll and Toy Fund, general chairman in
issuing the Mississippi Coast Guide book, and
her work toward making Harrison County and
Gulfport a better place in which to live.
She was active in the annual Doll and Toy
Fund work for approximately 25 years.
When Mrs. Williams was taken by death the
Gulf Coast lost one who had done much
through many years for the betterment not
only of her own community but of the entire
state. She was a woman of much initiative,
and leadership came to her naturally. Her
broad outlook and direct approach were per-
haps influenced by diverse conditions of ances-
try and places of residence. Both her Revolu-
tionary and Confederate ancestry were of
North Carolina, she being a descendant of
William Millikin who gave service in the War
for American Independence, and the daughter
of Samuel Hepler who was captain of a North
Carolina company in the War between the
States. Mrs. Williams was educated at the St.
Joseph Academy of Missouri and afterwards
went into training for the nursing profession.
She was graduated from Wentworth Hospital,
St. Joseph, Missouri, and following a few
years service was married in 1918 to Dr. D. J.
Williams, an outstanding physician of the
state and a recognized authority on public
health problems.
iShe came to make her home on the Missis-
sippi Coast, where she lived until her death.
Their beautiful Long Beach home has been a
center of hospitality and many distinguished
guests have been entertained there.
§
The foregoing briefly summarizes the life-
work of our Auxiliary mother, our organizer
and honorary president of the state organiza-
tion. Members of the Auxiliary know her as
counselor and guide, untiring in her motherly
direction and devotion to the growing organi-
zation. Rarely was Mrs. Williams absent from
a meeting, and rarely was a policy adopted by
the group that did not originate with her or
depend on her for promotion. Her guiding
spirit will be there in May to inspire, to en-
courage and to commend.
Our hearts are bowed in homage to a leader
whose place we shall to revere, but while
we bless her memory, we shall lift high the
torch which to us is flung.
January, 1946
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Carcinoma of the Stomach
ROBERT M. ROTH, M.D., M. S.
Staff Surgeon, Gamble Bros, and Archer Clinic
Greenville, Miss.
Medical references to carcinoma are
countless. Since no organ is exempt from
the ravages of malignant degeneration
all have been described in detail. There have
been articles, chapters, monographs, and even
books devoted to the subject of gastric carci-
noma. Yet, this should not shackle attempts
continually to renew our concepts and stimu-
late alertness. The generally accepted pessi-
mistic attitude of the profession toward the
established poor results of the treatment of
the disease is one in need of revision. Day
by day it becomes more evident that imputable
delay in diagnosis and consequently in early
surgical intervention is an all too common
occurrence.
The gravity of a condition which claims
approximately 35,000 lives annually in the
United States and accounts for from 20 per
cent to 30 per cent of all deaths due to car-
cinoma needs very little emphasis to be im-
pressive. It is pre-eminently a disease of mid-
dle life. This takes on added significance when
we view our declining birth rate and the in-
crease in the average life expectancy. In ad-
dition i3 the fact that the most recent report
of the United States Public Health Service
showed that deaths due to all types of carci-
noma are increasing in all sections of the na-
tion. The disease is much more common in
males than in females and accounts for almost
one-third of all carcinomas affecting men. In
both sexes, the stomach is the most frequent
site of carcinoma in the alimentary tract. The
greatest number of patients are between the
ages of fifty to sixty years, but all ages have
been reported.
There are many features of the disease
which cause consternation. Without a doubt,
the fact that we are dealing with an equation
in which the unknown X is the etiologic fac-
tor in carcinomas in general, is greatly re-
sponsible for this pessimistic attitude. The
lack of this knowledge precludes the possi-
bility of producing the disease experimentally.
These two factors combined offer the greatest
obstruction to diagnosis and treatment. The
problem becomes increased, when, added to
this, is the insidious nature of the disease, the
high grade of malignancy in most of these
lesions, and the tendency of the patient to
defer seeking early medical advice.
In recent years, there have been some im-
portant observations made concerning the eti-
ology of gastric carcinoma. Most pathologists
today support the idea that carcinoma rarely,
if ever, develops in an intact normal gastric
mucosa. It has been established that gastric
ulcers, adenomatous gastric polyps, and chron-
ic inflammatory changes in the gastric mucosa
are probably precursors to gastric carcinoma.
In addition, we now know that a certain per-
centage of benign gastric tumors will undergo
malignant degeneration. Further, since liver
therapy has been introduced into the treat-
ment of pernicious anemia, thus prolonging
the lives of these patients, there is evidence
that there is an increased predisposition for
gastric carcinoma in such people. The patho-
genesis of the malignant change is undoubted-
ly associated with disorganized hyperplasia of
the mucosa cells. Knowing these things, the
initiating of early prophylactic measures now
offers a promising influence on diagnosis, prog-
nosis and treatment.
We are well acquainted with the insidious
nature of this disease and its multiple mani-
festations. There is an enormous amount of
statistical evidence to support this. The most
comprehensive statistical study made over a
large group of patients was recorded in 1942
by Doctors H. K. Gray, W. Walters, and J. T.
Priestley in their book, Carcinoma of the
Stomach. These conclusions were drawn from
10,890 patients observed with gastric carci-
noma at the Mayo Clinic between (the years
1907-1938.
FIGURE I refers to the first presumptive
symptoms caused by gastric carcinoma.
Carcinoma — Roth
February, 1946
FIRST SYMPTOM EXPERIENCED
Dyspepsia 52%
Ulcer Symptoms 28%
Vague Abdominal
Distress 11%
General Decline 8%
Hemorrhage 1%
that small or circumscribed, innocent-looking
ulcerous gastric lesions may be actually or
potentially malignant. One problem which will
never be solved and one which has caused
great controversy is how many carcinomas ori-
ginate in ulcers and how many ulcers undergo
malignant degeneration. Stewart meets about
the mid-point of agreement when he states
that 9.5 per cent of all chronic ulcers become
carcinomatous and 17 per cent of carcinomas
have their origin in chronic gastric ulcers.
80 per cent obtained ‘‘effective” symptomatic re-
lief following palliative treatment for ‘‘ulcer-”
In over 50 per cent of the cases, indigestion
was the first disturbance noted. In almost 30
per cent it was the recurrent pain of ulcer-
like character. The vagueness of early symp-
toms is one of the reasons for late diagnosis.
FIGURE II shows that in more than half of
the cases the lesion had been causing symptoms
for more than a year prior to the time of sur-
gery. The vagueness of early symptoms makes
for late diagnosis and the late diagnosis is
without a doubt the most important reason
for unfavorable results of treatment.
INTERVAL FROM FIRST SYMPTOM, TO
OPERATION
Less than 3 mo. 18%
Less than 6 mo. 37%
Less than 1 yr. 49%
More than 1 yr. 51%
Of equal importance with the late diagnosis
is the extent to which the disease might pro-
gress before it causes symptoms at all. Of
the 10,890 patients observed, 4,648 patients
or 43 per cent of the total group were con-
sidered inoperable at the time of primary ex-
amination. Of this group, 26 per cent wqre
from those whose symptoms had existed for
an average period of only three months.
We, as physicians, take on a tremendous
responsibility to avert this tragedy of in-
operable carcinoma of the stomach. We are
not blameless and it is distressing that phy-
sicians, today, are still so perfunctory in
spite of all chat has been contributed to the
early diagnosis of gastric carcinoma. We are
obliged to become acquainted with the fact
Through repeated observation in the examin-
ing and x-ray room and in the pathologic
laboratory certain diagnostic conclusions of
relative value in the differentiating of benign
and malignant ulcers of the stomach have
developed. The typical benign ulcer is small.
Ninety per cent are less than one inch in
diameter, 90 per cent are single, and 90 per
cent are on the posterior wall near the lesser
curvature. In addition they have familiar x-ray
characteristics. In a patient less than thirty
years of age who has a small, single gastric
ulcer near the lesser curvature associated with
40 units of free hydrochloric acid following
a test meal, is usually benign. The benign
nature of the disease may be accepted if there
is permanent disappearance of all symptoms
and signs when subjected to adequate medical
treatment. This is true regardless of age of
patient or size or location of the lesion. How-
ever, if this response is not achieved, if the
lesion is large or exhibits the pathognomonic
meniscus sign on x-ray, if it is near the py-
lorus on the greater curvature and particularly
in old persons with late onset of symptoms,
an exploratory operation should be done with
the intent of gastric resection in view.
The former and present day prospects for
cure have greatly changed. In 1885 Welch had
made his extensive study of the problem. His
conclusion was most pessimistic and is best
expressed in his statement that' “no patient
subjected to resection survives longer than
one and one-half years.” From this time until
about 1910 there was but little accomplished
and almost thirty years after Welch’s paper,
Friedenwald presented 1,000 cases observed
by him in which radical operation was per-
formed in only 3.3 per cent. Since then ad-
vances in laboratory technique and in the
x-ray have aided materially in bettering the
prognosis. FIGURE III shows the disposition
regarding operability of the 10,890 patients
previously referred to.
February, 1946
Carcinoma — Roth
553
DISPOSITION OF PATIENTS WITH
RESPECT TO OPERABILITY
10,890 Patients
Inoperable
4,648
Observed.
43%
SUBJECTED TO SURGERY
Exploratory Lap.
2,431
6,242
22%
51%
Palliative Opr.
1,039
10%
LESION RESECTED
2,772
25%
In only 57 per cent of the cases observed
was surgery warranted and of these, 44 per
cent proved resectable so that 25 per cent of
the original group received the benefits of
resection. This leaves much to be desired but
does show marked improvement over that
situation which existed in the late eighteen
hundreds. These improvements are a reflection
of the modern laboratory, the vigilance of the
diagnostician and the boldness of the surgeon
in his acceptance of cases with obvious ex-
tensive involvement.
What then is the fate of the patient who
today develops a gastric carcinoma? FIGURE
IV shows a progressive depletion as observed
following diagnosis with only about 6 per
cent surviving the five-year test period.
FATE OF PATIENTS WITH GASTRIC
CARCINOMA TODAY
Total Pts. Obser. 100%
Subjected to Lap. 57.3%
Lesion Resectable 25.
Survive Resection 21.4%
Survive 3 years 8.3%
Survive 5 years 6.2%
However, those with resectable lesions have
a much better outlook and those without me-
tastasis still better. Patients with a low grade
carcinoma which has not metastasized have a
good chance (59 per cent) to regain health.
Today, this favorable condition is not seen
often enough. Only about one quarter have
resectable lesions and one-half of these have
metastasis. This explains the low percentage
of total patients observed who survive the
five-year period. It is reasonable to believe
that as diagnoses are made earlier higher
survival rates will be obtainable. It is this
end to which the medical profession must
strive.
In conclusion then, let us not view with
complacency a problem of so grave a nature.
We must be ever mindful of the predisposing
factors of gastric carcinoma so that early
prophylactic measures might be taken.
Especially those patients around forty years
who for the first time complain of dyspepsia
or ulcer-like symptoms, who are anemic, or
who show gradual general decline must re-
ceive the benefits of all of the diagnostic
recourses at our disposal. If a gastric ulcer is
discovered, no matter how small or innocent-
looking, it must be subjected to rigid ade-
quate medical treatment. If a permanent dis-
appearance of all signs and symptoms is not
achieved, laparotomy must be performed with
radical resection in view. It is only through
vigilance and the adequate use of our en-
hanced diagnostic and therapeutic knowledge
that progress can be made.
BIBLIOGRAPHY
1- Carcinoma Of The Stomach— 1942. Gray, Walters,
Priestley-
2- Importance of Cancer as a Cause of Chronic
Dyspepsia — Collected Papers of the Mayo Clinic
XXXI, 1939 — A. B- Rivers.
3. Association of Pernicious Anemia and Carcinoma
of the Stomach. Archives of Surgery 45:554-563
(Oct-) 1942 — P. C. Doehring and G- B. Eastennan.
4. Carcinoma of the Stomach : Early Recognition
and Results — Journal of Iowa State Medical So-
ciety 33:1-5 (Jan-) 1943 — James .T. Priestley-
5. Gastric Ulcer, Carcinomatous Ulcer or Ulcerating
Carcinoma? Annals of Surgery, 115:521-529 (Apr.)
1942 — Waltman Walters.
6. Carcinoma of The Stomach: A Challenge To The
Profession — G. B. Easterman- Collected Papers of
the Mayo Clinic XXXII, 1940.
7. Carcinoma of Stomach, 645-689- Gastroenterology
— Backus.
8. Text Book of Pathology — Bell-
9. The Surgical Treatment of Cancer Masquerading
as Benign Disease — W- Walters, W- H. Cleveland
Minnesota Medicine 23:709-711 (Oct.) 1940-
Be not prodigal of your opinions, lest by
sharing them with others you be left with-
out.
— Ambrose Bierce
Acute Intestinal Obstruction in Infants and Children:
Physiologic-Pathological Considerations
ROBERT M. MOORE, M.D.
Vicksburg, Miss.
There are no essential differences in the
acute intestinal obstructions of infancy
and childhood, and those occurring in
adults, except insofar as etiological factors
are concerned. MacCallum1 has stated, “No
matter what the mechanism in which occlu-
sion of the intestine is produced, the effect
is fairly constant, and varies only with the
completeness and situation of the obstruction.”
McGehee2 has emphasized, “The essential
pathology of acute intestinal obstruction is:
edema and spasm producing blockage, followed
by distention, producing a reverse peristalsis
(clinically manifested by vomiting) with a
final result of water loss, dechlorination and
toxemia.” Bartlett3 has also stressed the im-
portance of edema and spasm of the intestine
as final factors in mechanical obstruction.
In general, in acute intestinal obstruction,
that portion of the tract below the site of ob-
struction soon empties and becomes collapsed.
The part above the obstruction rapidly be-
comes distended from an accumulation of foul
smelling gas and fluid, the latter swarming
with bacteria; and even when there is no
obvious obstruction to its circulation the wall
of the intestine becomes so stretched as to
become paralyzed and discolored from venous
congestion. Edema results as the venous con-
gestion becomes greater. Later ulcerative nec-
rosis of the intestinal mucosa may develop,
and this is often associated with actual tears
in the muscularis and peritoneal covering of
the intestine. MacCallumi, citing Kocher, calls
these ulcers distention ulcers. It has been
thought that toxins and even bacteria might
pass through these weakened areas in the in-
testinal wall to produce a toxemia or peri-
tonitis, as the case may be. However, as Mac-
Callumi points out, there is no such profound
injury to the intestinal wall in many in-
stances, and no peritonitis, yet there are violent
and severe symptoms of toxemia.
*Read before the Meeting of the Issaquena-Shar-
key-Warren Counties Medical Society, Vicksburg,
Miss., February 12, 1946.
**Fathologist and director of the Clinical Labora-
tories, Vicksburg Hospital and Clinic, Vicksburg,
Mississippi. '
As a general rule, the symptoms of toxemia
are more severe when the obstruction exists
high up in the small intestine than when it
occurs in the rectum or sigmoid colon. Too,
according to MacCallumi the symptoms of
acute obstruction are much more severe when
strangulation due to the sudden shutting off
of the blood supply is superimposed on the
obstruction.
Two main theories, based on clinical observa-
tion and animal experimentation, exist con-
cerning the production of this toxemia. Can-
non and Murphy4, Whipple, Stone and Bern-
heim5, Whipple and Cooke6, and others have
placed emphasis on the absorption of a toxin
or toxins originating in the intestines or in-
testinal contents above the obstruction as the
cause of the toxemia. Haden and Orr7, Gatch,
Trusler and Ayres8, Burgess, Walsh and Ivy9,
Moss and McFetridgeio, and others have em-
phasized the chemical and physical changes
occurring in the blood and other tissues second-
ary to vomiting, which is so characteristic of
acute intestinal obstruction, as responsible for
the toxemias.
In recent years the toxin theory of ob-
struction toxemia has largely given way to
the chemical theory that toxic symptoms are
due to altered salt and water concentrations
in the blood and other tissues from vomiting,
and to increased tissue destruction as mani-
fested by an increase of the blood N.P.N. over
and above that expected by associated de-
pressed renal function.
As McGehee2 has so plainly written, ex-
cessive vomiting not only removes large
amounts of water, but also electrolytes, prin-
cipally chlorides and fixed base; and leaves
an excess of sodium radicals in the blood
which makes possible the retention of more
carbon dioxide, thus accounting for the in-
creased CO2 combining power of the plasma.
The excessive loss of fluids from vomiting
results in a concentration of the blood plasma;
and the attempted compensatory withdrawal of
tissue fluids to replace the plasma is reflected
in the general state of dehydration (dry skin
and shrunken subcutaneous tissues).
554
February, 1946
Intestinal Obstruction — Moore
555
This fluid loss may so greatly increase the
viscosity of the blood that it seriously inter-
feres with the respiratory and other functions
of the blood, and depresses renal function. A
consistent finding in acute intestinal obstruc-
tion is, according to McGehee2, an increase up
to 1000 pet* cent in the blood N.P.N., which
is manifested chiefly as an increase in the
urea fraction. McGehee2 further states, “It
seems certain that the increase in blood N.P.N.
is not altogether or mainly a retention phe-
nomenon. Despite the diminished renal func-
tion, there is an increase in nitrogen excretion
which may be four or five times the normal.
These facts are indicative of an intensive
increase in tissue destruction. Dehydration of
the tissues is the most likely explanation, al-
though the action of some circulating toxic
factor is not precluded.”
From the pathological standpoint, the acute
intestinal obstructions of infancy and child-
hood may be included in the clinical-etiological
classification of Wangensteenii, in which the
twenty-odd causes of acute obstruction are
grouped under four main types, namely: (a)
mechanical, (b) adhesive, (c) strangulation,
embracing intussusception, hernia, and volvu-
lus in the order mentioned, as the most com-
mon of these types.
In summarizing the frequency of occur-
rence of the different types of obstruction in
relation to age periods, Bolling12 briefly states
that in infants, at birth or immediately after-
wards, intestinal obstruction usually means an
imperforate anus, atresia of the intestine, or
a congenital volvulus. After this period and
up through the second year intussusception
is the most frequent cause of acute obstruc-
tion. Characteristic of this period also, but
occurring much less frequently, is the ac-
quired volvulus. After the second year, acute
obstruction is most commonly due to strangu-
lation of an internal or external hernia. Ob-
struction from postoperative bands and ad-
hesions, the impaction of a foreign body, oc-
cur next in frequency. These findings are
more or less in agreement with the findings
of Vick13. The actual pathological changes
occurring in the different types of strangula-
tion merit a more detailed study:
1. Intussusception. Invagination of one por-
tion of the intestine into another is the most
common single cause of acute obstruction in
infancy and childhood. Mclver14, quoting Ladd
and Cutler, and Peterson, state that 86 per
cent of all cases of acute obstruction occur-
ring in this age peeriod are due to intussus-
ception. It occurs spontaneously, and is thought
to be due to a hyperactive gut though Moore15
states, “There is usually no evident cause.”
As a rule the intussusception is single, and,
as might be expected, the direction of the in-
vagination is naturally in the direction of
peristalsis; though an occasional retrograde
invagination is encountered. The oldest and
perhaps the most simple classification of in-
tussusception divides it into three types,
namely: (a) enteric, in which the small in-
testine alone is involved, 10 to 15 per cent;
(b) colonic, in which invagination of the colon
alone occurs, about 6 per cent; and (c) ileo-
cecal, in which the terminal ileum, cecum and
ascending colon are involved. This is by far
the most common type, and includes prolapse
of the ileum through the ileo-cecal valve.
In many of these types the portion which is
invaginated drags with it its mesentery, while
the portion which receives the invaginated part
becomes so stretched that it constricts its con-
tents; especially at its beginning or upper end,
where the mesenteric mass is most bulky, it
forms a tight ring constricting the mesenteric
veins. This results in the production of a
hemorrhagic infarct in the two internal folds
of the invaginated gut. Due to the early venous
stasis, blood and lymph escape into the lumen
of the intestine, as well as into the wall, thus
accounting for the melena so characteristic
of this condition, and increasing the bulk of
the invaginated portion. In a few instances
the invaginated portion is said to become com-
pletely detached from the intestinal wall and
later to be expelled per rectum, but this must
be of rare occurrence.
2. Hernia. The second most common cause
of acute intestinal obstruction in infants and
children is, according to Mclver14, strangula-
tion of an internal or external hernia. The
hernia is formed also by the movements of
the intestine, but chiefly by the passive move-
ments caused from pressure of the abdominal
muscles or diaphragm. The hernia may be
single or double.
If, from a sudden violent exertion, a loop
of intestine is forced through a very narrow
opening, or if an excessive amount of in-
testine or too much intestinal contents be
forced into a previously formed hernia, the
afferent and efferent portions of the intestine
passing through the neck of the hernia sac
become obstructed. The compression of the
556
February, 1946
veins of the involved mesentery, which is
dragged into the sac with the loop of intestine,
soon causes edema and increases the contents
of the sac until circulation may become com-
pletely blocked; producing a hemorrhagic in-
farction. As the incarcerated portion of the
intestine becomes more or less isolated in a
tight-fitting sac, melena may or may not be
present, depending on the degrees of strangu-
lation.
In infants, the umbilical hernia, and in
older children the indirect inguinal and femoral
hernias, respectively, are the most common
of the external types. The internal hernias
are comparatively infrequent in children.
3. Volvulus. Acute intestinal obstruction pro-
duced by twisting or rotation of an intestinal
loop through an arc of 180 degrees, or more,
forms an interesting though relatively rare con-
dition as compared to the frequency of intus-
susception. Mclver14 did not find a single
case of volvulus during the first year of life
in his series of 335 cases of acute intestinal
obstruction.
A volvulus is usually single, but unless the
condition is relieved there is a marked tend-
ency for recurrence. Either the large or small
intestine may be obstructed in this manner,
but the most common sites are in the cecum
or sigmoid colon. The causes of volvulus are
obscure, but are thought to be due to ab-
normalities in rotation of the fetal gut, to lack
of mesenteric or colonic attachment, or to
bands and adhesions. An adherent Meckel’s
diverticulum may serve as a pivot around
which a portion of the intestine rotates. In
such instances there is the added probability
of a hyperactive intestine.
When a section of intestine undergoes ro-
tation around its mesenteric axis, or in some
instances around its own axis, an isolated
loop is formed with obstruction to its lumen
at both ends. The degree of interference with
the mesenteris circulation varies from a slight
congestion to complete venous blockage, de-
pending on the degree of torsion. Frequently,
however, the blockage is severe and in these
cases the isolated loop of intestine becomes the
seat of a hemorrhagic infarct. Again, melena
may or may not be present depending on the
degree of venous obstruction.
In the adhesive type of obstruction the con-
stricting veils or bands may be of congenital,
inflammatory or traumatic origin ; and less
frequently, at this age period, of neoplastic
origin. As a rule, the obstruction produced is
angular kinking of the intestine, though it
might be a simple constriction like that pro-
duced by a ligature, or it might resemble the
acute obstruction occurring from a strangu-
lated internal hernia.
SUMMARY
This is an abstracted review of the litera-
ture concerning the physiologic-pathological as-
pects of acute intestinal obstruction in infancy
and childhood; nothing new has been added to
the literature in this paper.
BIBLIOGRAPHY
1. MacCallum: Textbook of Pathology, 7th Ed-, W.
Saunders Company, Philadelphia, 1940-
2. McGehee, J. Lucius: The Mississippi Doctor, Feb.,
pp. 15-22, 1938.
3. Bartlett, Willard, Jr-: Surg-ery, Gynecology and
Obstetrics, November, 1933-
4. Cannon, W- B., and Murphy, F. T. : J.A.M-A.,
840, XL VIII.
5- Whipple, G. H-, Stone, H. B., and Bernheim,
B.M.: J. Exper- Med-, 17: 307-323, 1913, and other
papers.
6. Whipple, G. H-, and Cooke, J. V- : J- Exper-
Med., 25: 461-477, 1917, and other papers.
8. Gatch, W. D-, Trusler, H- M-, and Ayres, N. D-:
Amer. J- Med. Sciences, CLXXIII, 649, 1927-
9- Burgess, J. P-, Walsh, EL. and Ivy, A. C. : Proc.
Soc. Exper., Biol, and Med., XXV, 105, 1927.
10. Moss and McFetridge : Arch. Surg., 100, 158., 1934-
11. Wangensteen, Owen, H. : J.A.M-A., 101, 1532-
1538, November 11, 1933.
12. Bolling, R. W. : Ann. Surg., 349, 1923.
13. Vick, R. M. : Brit. M. J., 2: 546-548, 1932.
14. Mclver, M- A- : Arch. Surg., 25: 1098, 1932, and
other papers.
15. Moore, Robert A.: Textbook of Pathology, 1st-
Ed., W. B. Saunders Company, Philadelphia, 1944-
On his bold visage middle age
Had slightly press’d its signet sage
Yet had not quench’d the open truth
and fiery vehemence of youth:
Forward and frolic glee was there,
The will to do, the soul to dare.
— Scott
Varicose Veins
JOHN D. DYER
Houston, Miss.
We all can look back to only a few years
ago when the approach to the manage-
ment of varicose veins was entirely dif-
ferent from what it is today. The treatment
has changed from one of drastic to one of
simple surgical procedures.
The anatomical arrangement of veins is
such that certain patterns are usually found.
However, the veins vary so much in their
course and in their termination that a varia-
tion from the so-called normal can not be
called abnormal. The veins which return blood
from the lower extremity may be divided into
five groups: 1) deep veins of the leg, 2) super-
ficial veins of the leg emptying into the femor-
al (internal saphenous system), 3) superficial
veins of the leg emptying into the popliteal
(external saphenous system), 4) superficial
and deep veins of the leg emptying in the
internal iliac vein, and 5) communicating
veins.
Some of these veins have valves which pro-
ject into the lumen of the vein. These valves
lose their function in varicose veins for they
normally allow the blood to flow only up-
wards.
There is much more known about the path-
ology of varicose veins than about the patho-
genesis. Grossly, the varicose vein is elongat-
ed and tortuous. It has lost its elasticity and
is widely dilated. The collaterals are enlarged.
The exact cause of varicose veins is not
known. It is likely that a number of factors
are responsible. Some of these are familial
tendency, pressure on veins, pregnancy, en-
docrine factor, inflammation, and occupation.
Diagnosis is not difficult as it is usually-
made by the patient. However, every cause of
varicose veins should be investigated by special
tests to determine the following points :
1. Competency of the valves in the internal
saphenous system.
2. Competency of the valves in the com-
municating veins.
3. Patency of the communicating veins.
4. Patency of the deep veins.
5. Relative impairment of the arterial sup-
ply to the extremity.
♦Read before the Northeast Mississippi Thirteen
Counties Medical Society, Tupelo, December 11, 1945.
557
The following tests determine these points:
Brodie-Trendelenburg Test. This test deter-
mines the function of the valves of the inter-
nal saphenous. With the patient in the reclining
position, the extremity is elevated above the
level of the heart. After the veins are emptied,
the hand is placed over the upper end of the
internal saphenous vein and the patient is told
to stand up. Pressure is maintained momentari-
ly and the hand is then released. If the veins
fill immediately, it indicates that the valves
are incompetent and thus the test is positive.
A variation of this test is to maintain the
pressure of the hand when the patient stands
up. If the varicosities distend in less than
thirty-five seconds, it is an indication that the
valves of the communicating veins are in-
competent. If it requires more than thirty-
five seconds for the varicosities to distend,
the interpretation is that the valves of the
communicating veins are competent, because
these veins will normally distend through the
capillary bed in approximately thirty-five sec-
onds.
Parthes’ Test. This test is performed by ap-
plying a tourniquet around the upper thigh
tightly enough to compress the internal saphen-
ous vein and prevent the flow of blood in the
superficial system past this constriction. When
the patient walks, the varicosities improve if
the communicating veins and deep veins are
patent.
Comparative tourniquet test. This test was
devised by Dr. Howard Mahorner of Tulane
University. It combines the preceding tests.
It demonstrates the condition of the deep veins
and whether the valves of the communicating
veins are competent. If the valves of the com-
municating veins are incompetent, it shows
at what level the leaks occur. The patient is
first observed standing to find out the extent
of the varicosities. He is then told to walk
to and fro in front of the observer. He is
then stopped and a tourniquet is placed around
the upper third of the thigh just tightly
enough to compress the superficial veins.
Walking is then continued over the same
course at the same speed. The prominence of
the varicosities is noted and compared with
their prominence when the patient walked
558
Varicose Veins — Dyer
February, 1946
without the tourniquet. Next a comparison
is made with the tourniquet around the middle
third and finally with the tourniquet around
the lower third of the thigh. Thus, the vari-
cosities have been observed under five cir-
cumstances: standing, walking without a tour-
niquet, walking with a tourniquet around the
upper third of the thigh, walking with the
tourniquet around the middle third and walk-
ing with the tourniquet around the lower
third. The interpretation is as follows: If the
maximum improvement occurs when the tour-
niquet is around the upper third, and there
is not further improvement when it is placed
at lower levels, the retrograde flow is through
the main opening of the internal saphenous
vein. In cases where there is greater improve-
ment in the varicosities when the tourniquet
is around the lower third than when it is
around the upper third, the interpretation is
that the valves of the communicating veins
are incompetent.
The final test as to whether the enlarged
veins are varicosed or compensatory is the
bandage test. A four-inch ace bandage is ap-
plied about the leg from the ankle to the
knee. The patient is told to walk very fast
for fifteen to thirty minutes. If pain develops
in the lower leg and it increases, it is an
indication that the deep veins of the leg are
not patent and that the enlarged veins are
compensatory. On the other hand, if the en-
larged veins are typical varicose veins, the
leg will feel better after walking.
It is very dangerous to operate on a patient
for varicose veins without having determined
the five points mentioned above. Certainly, if
the deep veins are occluded it would be un-
wise to destroy the only veins left to return
the blood from the leg. If this should be done,
the leg would probably be lost and possibly
the patient.
The choice of treatment in most cases is
high saphenofemoral ligation with retrograde
injection. The operation is done under local
anesthesia and should be practically free from
pain. Dissection must be clean and the opera-
tive field should be kept bloodless. The in-
ternal saphenous vein should be freed all the
way into the foramen to where it empties
into the femoral vein. The operator should
be able to see the femoral vein above and be-
low the ligation is done flush with the wall
of the femoral vein. However, the proximal
stump of the saphenous is left about one inch
in length so that there will be no danger of
the ligatures slipping off. There are many
different types of solution which may be
used for the retrograde injection. We first
started using three or four cc. sodium mor-
rhuate. However, it was found that throm-
bosis was spotty. We have had much better
results since we started using varisol in large
doses. Usually about 40 cc. of varisol is in-
jected by means of a ureteral catheter. The
patient is told to walk at least ten minutes
out of each hour for the remainder of the
day until bedtime. After the first day he is
allowed to be up on his feet most of the
time. Checkups are made every two weeks
so that any remaining varicosities may be in-
jected. After all varicosities are corrected,
the checkups should be made once or twice
each year. By doing this any recurrence would
be found early and could be corrected before
it progressed very far.
If you wish to be happy for an hour,
get intoxicated.
If you wish to be happy for three days,
get married.
If you wish to be happy for eight days,
kill your pig and eat it.
But if you wish to be happy forever,
become a gardner.
— Chinese Proverb
Endometriosis
A CASE REPORT
W. L. STALLWORTH, M.D.
Columbus, Miss.
A case of endometriosis is presented
here, which due to the age of the pa-
tient, the extensiveness of the spread of
the endometrial transplants and the method
of handling the case, might prove an interest-
ing discussion.
A twenty-three-year-old woman appeared in
the out-patient department of a Navy clinic
complaining of a mass in the right inguinal
region. She had been delivered of a normal
male child six months previously, and had
noted this gradually enlarging mass in the
groin for (about three months. She complained
that this tumor became swollen and painful
during the menses, which began six weeks after
delivery.
Physical examination was essentially nega-
tive except for the tumor noted in the right
inguinal region. Pelvic examination at this
time showed nothing abnormal except for a
moderate erosion of the cervix.
She was advised to have the inguinal tumor
excised which was done under local anesthesia.
The tumor was found to be a spindle shaped
enlargement of the round ligament measuring
8x4 cms. well encapsulated. The pathological
report was endometriosis of the round liga-
ment.
She was not seen again at the clinic for
a period of two months. Her home was in a
smaller town nearby and she was sent into the
hospital by a civilian doctor with a diagnosis
of a ruptured ectopic pregnancy.
The previous month she had also experienced
severe low abdominal cramps, with some uri-
nary discomfort, necessitating the giving of
opiates.
At this time of admission to the hospital
it was evident that she had lost considerable
blood, and seemed to be in a critical condition
due to an acute abdominal condition. Im-
mediately 500 cc. of citrated blood were ad-
ministered and repeated the following day. Ab-
dominal examination revealed some splinting
of the abdominal muscles, and acute tender-
ness over the whole of the lower abdomen.
Pelvic examination revealed both ovaries
cystic with nodular masses present bilaterally.
Numerous small nodular masses were felt in
the posterior cul-de-sac on rectal examination.
Due to the findings on the previous admission
the diagnosis of extensive pelvic endometriosis
was agreed upon.
Accordingly the day after admission a lapa-
rotomy was performed under general anesthe-
sia. Numerous adhesions between the pelvic
viscera were encountered. The ovaries were
cystic, and appeared to contain the typical
chocolate colored blood. There was also con-
siderable free blood in the peritoneal cavity.
The whole of the pelvic organs was studded
with numerous small endometrial transplants
which made it immediately evident that their
entire removal was hopeless. No attempt was
made to break up the numerous adhesions
present.
It was agreed upon that the best solution
of the problem, even though the patient was
only twenty-three years of age, lay in arrest-
ing ovarian function. Accordingly after re-
covery from the operation she was referred
to a competent radiologist for deep x-ray ra-
diation of the ovaries. The decision brought
on some rather sharp criticism from several
sources but two prominent gynecologists, who
were present in the surgery and were called
in, agreed that less mutilation would be done
by the procedure we followed. Unfortunately
I have not been able to study this case fur-
ther, due to the fact that shortly after her
discharge from the hospital she followed her
husband to the Pacific Coast and has not re-
sponded to any correspondence.
Endometriosis occurs most frequently in
white women in their early thirties who have
been sterile for several years. The case re-
ported is an exception in that this extensive
process occurred in a young woman who had
delivered a normal child six months previous-
ly. No pelvic surgery had been done to ac-
count for the widely disseminated lesions that
could have resulted from a spilling of endo-
560
February, 1946
metrial tissue into the peritoneal space. Re-
gurgitated endometrium through the fallopian
tubes, activated by a high estrogenic blood
level, seems the most plausible explanation.
BIBLIOGRAPHY
1. Sampson, J. A-, Arch. Surg’., 1921, 3: 245-323-
2. Idem. Am. J- Path., 1927, 3: 93-109.
3- Idem. Am. J- Obst., 1922, 4: 451-512-
4. Wolford, T. F-, The Miss. Doctor, 1943, pp. 492-494.
5. O’Conner, Greenhill, The American Journal of Ob-
stetrics-Gynecology.
6- Richard R. Stephenson, M.A-, and Peter Graf-
fagnino, M.D., Southern Medical Journal, May
1942, Vol. 35, Page 525-
7. Richard B. Cattell, M-D., and Neill W- Swinton,
M.D., The New England Journal of Medicine, Vol,
214, Pag-es 342-346-
8. Curtis H. Tyron, M-D., Reprinted from the South-
ern Surgeon, October, 1935, Vol- 4, Pages 345-352.
9- Emil Novak, M.D., F.A.C-S , New Series, The
American Journal of Surgery, Sept-, 1936, Vol.
33, Pages 422-427 and 421.
10. Floyd E- Keene, M.D-, and Robert A. Kimbrough,
Jr., M.D., Southern Medical Journal, February
1929, Vol- 22, Page 101.
11- G. C. Milner, M-D., and I- L. Telden, M.D.,
American Journal of Obstetrics and Gynecology.
August, 1942, Vol. 44, Page 322.
THE BATTLE AGAINST CANCER
— An Editorial by Morris Fishbein
Among the most conspicuous problems in
the control of cancer is the difficulty of getting
the patient to seek medical care soon enough
to permit medicine to do for him all that can
be done. In many instances patients frequently
delay because of ignorance or fear in seeking
medical care. In some instances, of course,
doctors fail to carry out enough scientifiic
study to detect the presence of cancer that
is not easily detectable. This means that more
and more education is needed in regard to the
importance of early recognition and treatment
of cancer. If people would only try to call
attention to suggestive symptoms as soon as
they are noticed and if there were avaiilable
everywhere opportunities for immediate con-
sultation with physicians who had access to
the necessary aids for diagnosis, the number
of needless deaths from cancer would be great-
ly decreased.
In Great Britain, under the British Cancer
Act of 1939, the country is divided into re-
gions in which there are available diagnostic
units, treatment centers and facilities for the
care of advanced cases. A similar program is
now in process of development for the United
States with the aid of funds to be provided by
the American Cancer Society. Both the Ameri-
can Medical Association and the American
College of Surgeons are cooperating in the
development of principles and practices which
should make this plan effective.
Regardless, however, of the facilities and
the medical advice that are available, these
can do little to reduce the total number of
unnecessary deaths unless people learn to over-
come their fears and to seek the aid of these
facilities at the earliest possible moment. In
Sweden under a government system there are
available to the people free diagnostic services
and free transportation to government clinics
with easy access to surgery and radium. Never-
theless, these facilities do not seem to have re-
duced materially either the deaths from can-
cer or the death rates. In a personal inquiry
made to the physician in charge of one of the
great cancer centers — the Radium Hemmet in
Stockholm — he said that the public still fears
cancer so greatly as to postpone the visit to
the general practitioner in rural areas, who
is in the vast majority of cases the first phy-
sician consulted.
In the United States cancer of the breast
caused 16,140 deaths in 1943; cancer of the
uterus caused 16,968 deaths; cancer of the
larynx caused 1,490 deaths; cancer of the
tongue, 1,231 deaths; and cancer of the lips,
661 deaths. With the knowledge now available
many of these deaths could have been pre-
vented. These forms of cancer are in the ma-
jority of instances curable in their early stages.
The figures cited indicate great possibilities
if educational and medical ficilities can be
utilized to the utmost in getting the patient
to the doctor as soon as possible and making
available to the doctor modern methods for
diagnosis and treatment.
February, 1946
Editorials
561
The Mississippi Doctor
Published monthly at Booneville, Mississippi-
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
W. H. ANDERSON, M.D- Editor-in-Chief
MILDRED P. ANDERSON. Assistant Editor
David E. Guyton, Blue Mountain College Poet
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D. Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M- D Vice-President
El Dorado, Ark.
A. F. Cooper, M- D Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis, Tenn.
E. M. Holder, M. D. C. R. Crutchfield, M- D.
F. M. Acree, M. D. H. King Wade, M. D.
Lawrence W. Long, M-D.
J G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M-D., Suite 412 Standard Life Building,
Jackson, Mississiippi.
ANSWERS LAST SUMMONS
DR. W. S- LEATHERS
The doctors of Mississippi are deeply griev-
ed over the death of Dr. W. S. Leathers, dean
of Vanderbilt Medical School. As dean of
our two-year medical school and as executive
secretary of our state board of health, he
rendered great and valuable service to Missis-
sippi for many years. In public health and
as a medical dean he was well-known through-
out the nation. As a teacher in the medical
school at Ole Miss he was one of the best
we have ever known. He taught well because
he knew his subject very definitely and he
was painstaking and reasonable with his stu-
dents.
Dr. W. S. Leathers was a courtly, Christian,
Southern gentleman of the very finest type.
Duty was his watchword. He loved to train
young men to be thorough and to serve well.
His love for Mississippi never wavered. He was
anxious to see our state have a four-year
medical school and many of our thinking doc-
tors who loved him hoped to have him as
dean of our school when established.
In the death of Dr. Leathers Mississippi lost
a friend whom it loved affectionately, the
Southern states lost a noble son, and the na-
tion lost a great scientist and an outstanding
leader in public health and medical education.
§
DR. EDWIN H. CAREY
Doctor E. H. Carey of Dallas, Texas, was
recently presented the Linz Award for out-
standing community service in 1945. Dr. Carey
is an enthusiastic civic-minded citizen. His
outstanding work for Dallas has been as presi-
dent of the board of trustees of Southwestern
Medical Foundation. For twenty-five years or
more Dr. Carey has dreamed of and worked for
this great medical center which is now a re-
ality. This center is outstanding in the South-
west.
Dr. Ed Carey, as he is fondly known by most
people, is a native of Alabama. He was born
February 28, 1872, in Union Springs. He is a
graduate of Bellevue Hospital Medical College,
and during an outstanding career has served
as president of both the American and the
Southern Medical Associations. He is a great
student in medical economics and is deeply in-
terested in the social uplift of all the people.
In medical policy he is the best informed and
safest leader we think of to be found in this
nation. We would do well to listen to his coun-
cil and follow his leadership around the per-
nicious threat of state medicine. The medical
562
Editorials
February, 1946
profession of the nation is proud of Dr. E. H.
Carey as an outstanding man in his pro-
fession, and an enthusiastic civic leader, as a
medical statesman, and a positive, warm-heart-
ed, inspiring personality.
§
At the joint meeting of the Northeast Mis-
sissippi Thirteen Counties Medical Society and
the North Mississippi Society at Oxford on
Tuesday, March 12, the matter of consolidation
of the two societies into the North-Northeast
Mississippi Medical (Society will be considered.
The Northeast has already expressed itself
as being glad to join hands with the North
Mississippi. Since our doctors are cut down so
much in number and since our means of travel
are improving it seems that there might be
many advantages in the consolidation.
§
The Southeastern Surgical Congress holds
its first session since the war in Memphis,
March 11-13. Dr. Alton Ochsner of New Or-
leans, head of the Ochsner Foundation, is
president. The Ochsner foundation is rapidly
developing into one of the South’s greatest
medical centers. The Southeastern Surgical
Congress is one of our very best scientific or-
ganizations within the medical profession. We
are sure that the attendance will be as large
as the hotel accomodations in the Bluff City
will permit.
§
Dr. G. S. Bryan of Amory, beloved by all,
is asking every doctor to send him a picture
of himself and a brief history of his life and
work. Such a collection will be very valuable
in the years to come, and it will give Dr. Bryan
a lot of pleasure now since he has retired from
active practice.
§
HOSPITAL SERVICE
February 20, for Mississippi medicine, was
a very important day in our state legislature.
The four-year medical school was set for spe-
cial order. Practically all members acknowled-
ged that Mississippi needs more and better
medical service. But there are three definite
schools of thought on how to secure it. One
insists on more and bigger hospitals as the
only way to better medical service. Another
insists on the four-year medical school as
the chief essential, and still another sees
the need of the four-year school with an af-
filiated hospital system to support it. This
last group envisions an extension consultation
service from the four-year school and the
central hospital by way of the smaller hos-
pitals of the state, carrying a better medical
service right to the people. It also favors
nurses securing half or more of their train-
ing in the smaller hospitals and then finish-
ing in the university hospital or the larger
ones affiliated with it, and interns serving
from three to six months in the smaller hospi-
tals as part of their training.
The house was called to order at two o’-
clock and the fray was on. Former Governor
Hugh White led the fight for the four-year
medical school, and did it in a masterly man-
ner. A motion was soon made to defer action
for one week — then the tug of war was on.
Different opinions for and against the school
were discussed pro and con. As the debates
continued the thinking elements on either side
began to come closer together on the view
that the school and the hospital system
should go hand in hand if the people of the
state are to have beeter medical service.
Representative Littleton Upshur was a co-
leader with Mr. White for the bill. His plea
for a four-year medical school with an affiliat-
ed hospital system was logical and convincing
and very eloquent with facts and reason.
The opposition to the four-year school asked
that the matter bedeferred for a week. The
battle raged for about two hours, the vote
was taken and history was recorded. The vote
was sixty-nine to sixty-five in favor of the
school. The crowded galleries, most of whom
were decidedly in favor of the complete ser-
vice, the school and the hospital system, sat
tense while the vote was registered.
After the vote an amendment was added
providing that the hospital system be com-
pleted before the school is inaugurated. This
should not have been added perhaps, but the
victors were big-hearted and wanted to be
nice to the minority. After all it was a brother-
ly get-together move, each side showing faith
in the integrity of the other.
The able, unbiased, thinking members of the
legislature are coming steadily to the view
that the school and the hospital system must
go together and that it will take some time
to give us the perfected service, but that we
must start now with the school and with
enough of the hospital system to carry it
February, 1946
563
along. The indications are that the senate
will favor the completed service, the school
and the affiliated hospital system for every
county according to its needs and according
to what it can utilize at this time. This is the
just and the reasonable conclusion.
In medical service to all the people we ven-
ture to predict that Mississippi is going to show
the way to the nation.
FROM DR. BRYAN
Call him not dead whose good works and
wholesome influence still live. Thus I reasoned
when the press announced that Doctor W. S.
Leathers was dead. Doctor Leathers was born
of Virginia. He taught, for a time after his
lottesville in that old state. He was educated
in and graduated from the classic University
of Virginia. He aught, for a time after his
graduation, in the University of (South Caro-
lina. He then joined himself to the faculty
of the University of Mississippi. He organized,
inaugurated, and directed the medical depart-
ment there for many years. It is largely due
to his vision and wisdom that this institution
has taken such high rank among the two-
year medical schools of the nation.
In addition to the delicate and arduous
duties devolving upon him as dean of medi-
cine and teacher in this school, he was in-
duced to take over the direction of the pro-
gram of public health being inaugurated by
Mississippi’s Board of Health. This was, I
think, in 1914. At any rate, it was during my
incumbency as president of the Mississippi
State Board of Health. Thus it was that I
had opportunity to observe the man and his
methods. The results of his wisdom and genius
can still be seen in the splendid work that is
now being done by this board of health. I
became acquainted with Doctor Leathers in
the early 1900’s. During those days he made
frequent visits to my office. Recognizing him
as a highly cultured Southern gentleman, I
soon learned to love him as a friend.
In 1924 he left Mississippi, to go to Nash-
ville where he became professor of preventive
medicine at Vanderbilt. In 1928 he became
dean of medicine in that great institution
which place he held until June 1945 when he
became dean emeritus. On January 4, 1946,
he suffered a paralytic stroke from the ef-
fects of which he succumbed on January 26,
1946. I saw him seldom after he went to
Nashville but our friendly relations did not
suffer in consequence of this separation. I
wish to pay tender but sincere tribute to him
and this memory of that occasion. In the
spring of 1944 I went as fraternal delegate
to the Tennessee Medical Association. On my
arrival in the city, I went immediately to the au-
ditorium where the association was in session-
When I entered, Doctor Leathers was discuss-
ing some paper or issue that had been pre-
sented. At the close of his discussion he came
and seated himself by my side. From then
on during my stay we were scarcely separated.
Due to his graciousness, I was included among
the elite of the association in a special enter-
tainment, given jointly, by Dr. O. N. Bryan
(who was, at the time, president of the as-
sociation) and Dr. Shoulders (who is now
president of the A. M. A.). The first session
of this entertainment was a stand-up affair
in the spacious home of Dr. Bryan. The closing
session was a magnificent banquet given at
Belmeade — the beautiful, the romantic, the
historic old Belmeade.
Doctor Leathers was loyal to friends and to
principles. And after all, loyalty is the test
of character. My tears and my homage are
freely offered. A good and great man has lived
and labored among us and has passed from the
stage. We may not soon see his like again.
G. S. B.
As a rule if you wish to secure the best
nurse available, find one trained in a twenty-
five to one-hundred-bed hospital.
§
Federal aid for the lower income bracket
for hospitalization and for medical and surgi-
cal fees is much better than to have fastened
upon us the Wagner bill in all of its damaging
ramifications. Personal effort should continue
to be inspired by meritorious service and the
patient-doctor relation should be guarded as
human life.
§
We have committed the Golden Rule to
memory; let us now commit it to life.
We have preached Brotherhood for cen-
turies; we now need to find a material basis
for brotherhood. Government must be made
the organ of Fraternity — a working-form for
comrade-love.
Think on this — work on this.
— Edwin Markham
News and Comment
NORTH MISSISSIPPI HOSPITAL DEDICATED
Dedication of the North Mississippi Hos-
pital February 15, was an outstanding event
in north Mississippi and the result of a long
effort in the legislature for a hospital unit
north of Jackson.
The idea was born in the mind of the
late Dr. A. M. McAuley, prominent physician
of Marshall County, who in 1927 asked Fred
Belk, then a member of the legislature, to
start a fight for a small hospital. Each session
since that time has tried for funds for the
hospital.
College Plant Purchased
In 1944 the Marshall County legislators,
composed of Dee Howard, Robert Reed, Bob
Bonds and Deaton McAuley, son of the late
Dr. McAuley, and the legislators from Tate
and DeSoto counties, with the cooperation of
legislators from central and south Mississippi,
were able to get an appropriation of $50,000.
Marshall County purchased the Missis-
sippi iSynodical College and grounds that cover
a city block and offered it to the three coun-
ties for a hospital. The building of the hos-
pital was under the direction of a board of
trustees: H. A. Harris, chairman, Marshall
County; C. S. Baker, Tate County; W. P.
Winn, DeSoto County, and Fred Belk, secre-
tary and attorney of the board.
The framework of the college was torn
down and on the site was built a splendidly
equipped hospital with thirty beds. This con-
nects with the brick structure of the M. S.
College in which it is hoped to add another
unit. The twenty beds in this unit are being
used for the nurses.
Dr. V. B. Philpot is surgeon in charge;
Miss Martha McVey, executive secretary; Miss
Margaret Gooch, bookkeeper, and the follow-
ing nurses and nurses aides: Mrs. Helen Cox,
Mrs. Sue Hardy, Miss Mary Fields, Miss Jane
Graham, Miss Jean Eaves, Mrs. June Dixon,
Miss Patricia Griswold, Mrs. A. N. Barnett
and Mrs. Elmo Churchill.
The negro unit has Mae Florence Owen,
Rosie Lee Freeman and Rebecca Smith as
nurses.
The hospital was dedicated in a ceremony
at 7 p.m. Dr. Harry Leland Martin of Sena-
tobia was the speaker, Hindman Doxey, mas-
564
February, 1946
The Mississippi Doctor
565
ter of ceremonies; the Rev. Dewitt Smith read
the Scripture and the Rev. C. T. Floyd gave
the dedicatory prayer.
The history of the hospital was given by
Frank Belk, attorney. The addresses for the
evening were by Dr. Felix Underwood, State
Board of Health, and Perrin Lowrey. Dr. Phil-
pot, surgeon in charge, was introduced and ex-
pressed his appreciation. The master of cere-
monies, Hindman Doxey, also introduced many
distinguished Mississippians who attended.
This is one of the most modem hospitals in
the state, well built and well equipped in every
way. It is well staffed with good nurses and
other help.
The official staff of the hospital follows:
President, Dr. Ira Seale, Holly Springs;
vice president, Dr. C. W. Emerson, Hernando;
secretary, Dr. V. B. Philpot, surgeon in charge.
Meetings of the staff will be held on the
second Tuesday of each month.
All medical doctors of Marshall, Tate and
DeSoto counties are members of the staff.
They are listed by counties as follows:
DeSoto County: Dr. C. W. Emerson, Dr.
D. C. Funderburk, Dr. L. L. Minor, Dr. A. U.
Richmond, Dr. H. A Stewart, Dr. J. M. Wright.
Tate County: Dr. H. F. Byers, Dr. J. J.
McAuley, Dr. A. D. Powers, Dr. J. C. Powell,
Dr. M. M. Powell, Dr. W. C. Smith, Dr. L. L.
Welborn and Dr. H. H. Rutledge.
Marshall County: Dr. C, C. Conner, Dr.
Norman Gholson, Dr. R. G. Grant, Dr. D. R.
Moore, Dr. H. S. Phillips, Dr. Ira Seale, Dr.
C. R. Senter, Dr. Edward Thorne, Dr. F. K.
West and County Health Officer Dr. Jack
Young.
PHYSICIANS RETURNED FROM MILITARY
SERVICE
Dr. A. A. Derrick, Natchez, Mississippi
Dr. Eldon L. Bolton, Biloxi
Dr. D. M. Pennabaker, New Albany
Dr. T. R. Ramsey, Laurel
Dr. J. D. Hutchins, New Hebron
Dr. James A. Clark, Jr., Parchman
Dr. L. M. Lipscomb, Jackson
Dr. L. L. McDougal, Jr., Booneville
Dr. James G. Blaine, Hazelhurst
Dr. George B. Neukom, Doddsville
Dr. E. H. Crawford, Tylertown
Dr. B. R. Wilson, Carthage
Dr. W. E. Johnston, Vicksburg
Dr. Ralph Sneed, Clarksdale
Dr. W. H. Lunceford, Sardis
Dr. W. F. Hand, Jackson
Dr. Thomas L. Moore, Jr., McComb
Dr. W. P. Warfield, Clarksdale
Dr. Ellis D. Parker, Laurel
Dr. W. R. Armstrong, Iuka
Dr. G. C. Verner, Jaikson
Dr. W. H. Cave, Greenville
Dr. B. F. Hand, Greenville
Dr. A. E. Brown, Columbus
Dr. J. R. Lavender, Columbus
Dr. H. H. McClanahan, Columbus
Dr. G. G. Townsend, Morton
Dr. R. A. Strong, Pass Christian
Dr. G. K. Rogers, Belzoni
Dr. L. B. Merriam, Waynesboro
Dr. G. Y. Hicks, Vicksburg
Dr. W. J. Witt, Jackson.
SUMMARY OF PRINCIPLES EVOLVED
IN DISCUSSION OF NOVEMBER 30, 1945
The special committee of the conference
reviewed the proceedings and crystallized sug-
gestions, which were based on the suggestions
offered at conference: that the Council on
Medical Service and Public Relations obtain
from the House of Delegates authorization to
develop a national voluntary prepaid medical
plan along the following guiding principles:
1. The plan should be a (non-profit) stock
corporation.
2. It should be chartered in one of the
states and licensed to do business in all the
others.
3. It should be under medical control.
4. Its original financing should be from
medical sources, by contributions — loans with-
out interest — from state medical societies and
from local and state voluntary prepaid medical
plans to be matched by grants from the Ameri-
can Medical Association.
5. The coverage at first should be surgical
and obstetrical care on an indemnity basis.
6. It should be conveniently integrated with
plans for hospital care.
7. The purposes should be a) to provide
coverage in areas where no plans exist until
such time as they can be developed; b) to
encourage the development of voluntary pre-
paid medical plans where they are lacking; c)
to supplement local and state plans in pro-
viding coverage for national enrollment
566
February, 1946
groups; d) to encourage local and state plans
to provide an appropriate coverage for the
lower income group and for those whose costs
of medical care are borne by taxation; e) to
encourage local and state plans to extend
coverage as rapidly as is consistent with
sound practice to include medical as well as
surgical and obstetric care.
Terminating two years as director of the
Department of Public Relations and secretary
to the Council on Public Relations of the
American Hospital Association, Jon M. Jonkel
announced his resignation effective January 5
to establish an organization specializing in the
public relations problems confronting hospitals.
A broad public education program is ex-
tremely important at the national level, ac-
cording to Mr. Jonkel, but individual hospitals
too must engage in continuous programs that
will improve and maintain the quality of pub-
lic opinion about hospitals. The contemplated
public relations program of the Association
will call attention to hospitals’ contributions
to the national welfare but each hospital must
adjust its public relationships and should ex-
plain itself to the public that supports it if
continued support is expected.
Mr. Jonkel will offer assistance in the public
relations programs of individual hospitals and
will serve as a public relations consultant in
fund raising campaigns. His services will in-
clude public opinion surveys, an audit of the
hospital’s work that has a bearing upon public
opinion, preparation of year-long public edu-
cation and employee programs, and the de-
velopment of the materials that will imple-
ment any recommended program.
DIRECTORY OF APPROVED SURGICAL
TRAINING PLANS PUBLISHED BY
AMERICAN COLLEGE OF
PHYSICIANS
Chiefly as an aid to medical officers re-
turning from war duty, the American College
of Surgeons has published a 424-page directory
in which are listed and described the approved
programs of graduate training in surgery in
240 civilian hospitals in the United States and
Canada, and in 32 Naval, 7 Veterans Adminis-
tration, and 10 United States Public Health
Service hospitals.
The total number of approved training plans
in the 269 hospitals is 228 in general surgery
and 522 in the surgical specialties — fractures,
plastic surgery, proctology, thoracic surgery,
neurological surgery, orthopedic surgery, urol-
ogy, obstetrics and gynecology (combined and
separately), and ophthalmology and otolaryn-
gology (combined and separately). In these
750 training plans in 289 hospitals, approxi-
mately 2,000 surgeons may be trained, where-
as, as the College points out, training facilities
for at least 5,000 are urgently needed for re-
turning medical veterans whose training in
surgery was interrupted by their military ser-
vice. Publication of the directory is expected
to stimulate the formation of additional pro-
grams of training in suitable hospitals, accord-
ing to Dr. Irvin Abell, chairman of the Board
of Regents.
THE STATE MEETING
Before we know it, our state meeting will
be on hand. Let us make ready rapidly. The
meeting will be held at Jackson at the Robert
E. Lee Hotel, May 14, 15, and 16, if we have
the regular three-day session. We should have
a fine meeting this year. It will be a good time
to review what the war taught us and to plan
for better medical service for our people. Many
familiar faces will be missed at our next meet-
ing. Just the delegates were present last year,
and within the last two years some of our
finest leaders in the profession have passed
on. Deaths during the war have far exceeded
the replacements by men returning from the
service.
Two years ago he Half Century Club was
organized, men who had practiced fifty years
being qualified. We are extending an invitation
again to the men who have practiced for fity
years to be our guests at a luncheon. We hope
that every one in the state will be present if
a all possible. The knowledge and he wisdom
of these men are very valuable.
The past-presidents’ meeting is always a fine
feaure at the state association. And the public
night which was instituted a few years ago,
will help o bring about an understanding be-
tween the profession and the laity. We hope
now that the war is over this night will also
be resumed.
The various section chairmen are busy
working on the program. Make your plans to
attend.
The Woman’s Auxiliary will resume its state
meeting simultaneously with the scientific
session. Mrs. L. J. Clarke, Vicksburg, is presi-
dent.
OFFICER'S 1945-46
PRESIDENT
B. Lampton Crawford Tylertown
PRESIDENT-ELECT
J. K. Avent Grenada
VICE-PRESIDENTS
E. K. Guinn Okolona
J. T. Weeks Jackson
L. W. Brock . McComb
HISTORIAN
J. G. Thompson Jackson
EDITOR
Lawrence W. Long Jackson
ASSOCIATE EDITORS
Stanley A. Hill ( One Year) Corinth
L. Hughes ( Two Years ) Jackson
SPEAKER OF THE HOUSE
J. Rice Williams Houston
TREASURER
J. F. Lucas Greenwood
SECRETARY
T. M. Dye Clarksdale
COUNCIL
First District
J. W. Lucas Moorhead
Bolivar, Coahoma, Humphreys, LeFlore, Quit-
man, Sunflower, Tallahatchie, Tunica ,
Washington
Second District
L. L. Minor Route 4, Memphis, Tenn.
Benton, DeSoto, Lafayette, Marshall, Panola,
Tate, Tippah, Union, Yalobusha
Third District
R. B. Caldwell Baldwyn
Alcorn, Calhoun, Chickasaw, Clay, Itawamba,
Lee, Lowndes, Monroe, Noxubee, Oktibbeha
Pontotoc, Prentiss, Tishomingo
Fourth District
W. H. Curry Eupora
Attala, Carroll, Choctaw, Grenada, Holmes
Montgomery , Webster
Fifth District
H. C. Ricks Jackson
Claiborne, Hinds, Issaquena, Leake, Madison,
Rankin, Scott, Sharkey, Simpson, Smith,
Warren, Yazoo
Sixth District
Lamar Arrington Meridian
Clark, Kemper, Lauderdale, Newton, Neshoba,
Winston
Seventh District
R. F. Ratliff Lucedale
Covington, Forrest, George, Green, Jasper >
Jefferson Davis, Jones, Lamar, Marion,
Pearl River, Perry, Wayne
Eighth District
W. H. Frizell Brookhaven
Adams, Amite, Copiah, Franklin, Jefferson,
Lawrence, Lincoln, Pike Walthall,
Wilkinson
Ninth District
D. J. Williams Gulfport
Hancock, Harrison, Jackson, Stone
COMMITTEES
PUBLIC POLICY AND LEGISLATION
A, Street, ( One Year) Vicksburg
Henry Boswell (Two Years) ....—.Sanatorium
W. H. Anderson ( Three Years) Booneville
PUBLICATION
L. W. Long, Editor Jackson
Stanley A. Hill ( One Year) Corinth
L. Hughes (Two Years) Jackson
PROGRAM
THE SECRETARY
CHAIRMEN OF SECTIONS
CONSTITUTION AND BY-LAWS
D. W. Jones (One Year) Jackson
W. W. Crawford (Two Years) Hattiesburg
W.H. Frizell (Three Years) Jackson
BUDGET AND FINANCE
Gilruth Darrington (One Year)... .Yazoo City
George Adkins (Two Years) Jackson
B. B. O’Mara (Three Years) Biloxi
EXHIBITS
D. W. Jones (One Year) Jackson
J. G. Thompson (Two Years) Jackson
George Riley (Three Years) Jackson
CHAIRMEN OF SECTIONS
MEDICINE
H. C. Sheffield Jackson
SURGERY
A. B. Harvey Tylertown
PUBLIC HEALTH
T. Paul Haney Laurel
EYE, EAR, NOSE AND THROAT
S. B. Caruthers Grenada
568
The Mississippi Doctor
February, 1946
TO HAVE VETERANS HOSPITAL
The progressive city of Tupelo looks forward
in hospital facilities. The news comes that
$200,000 will be added to their already very
fine local hospital which cost more than $300,-
000. In addition to the big addition to the
local hospital, this progressive city is assured
of a 250-bed veterans hospital. These additions
are calculated to make Tupelo a hospital cen-
ter.
NEWTON COUNTY MEDICAL SOCIETY
ELECTS
The following officers for 1946 have been
elected by the Newton County Society:
Dr. E. L. Laird, Union, president; Dr. Omar
Simmons, Newton, vice-president; Dr. Dudley
Stennis, Newton, secretary; Dr. Z. C. Hagan,
Union, delegate to Mississippi State Medical
Association; and Dr. Dudley Stennis, Newton,
censor.
DR. MOORE HEADS ARKANSAS GROUP
Dr. Berry L. Moore of El Dorado was elect-
ed president of the Fifth Councilor District
Medical Society at the semi-annual meeting
in El Dorado last month, succeeding Dr. J. P.
Clements, Stephens. Other new officers: Dr.
John P. McAlister, Camden, vice-president,
succeeding Dr. L. A. Longino, Magnolia, and
Dr. Joe B. Rushton, Magnolia, secretary, suc-
ceeding Dr. E. J. Munn, El Dorado.
Technical talks were heard from Dr. Allen
Oschner of New Orleans and Dr. W. W. Scott
of Chicago at a dinner attended by fifty phy-
sicians.
DR. ROWLAND IS ELECTED
Dr. Driver Rowland was elected president of
the Methodist Hospital staff at the February
meeting.
Dr. Jedd Scott was named vice president
and Dr. Frank Burton, secretary-treasurer.
UROLOGY AWARD
The American Urological Association offers
an annual award, not to exceed $500, for an
essay (or essays) on the result of some
specific clinical or laboratory research in
urology.
“Essays must be in the hands of the secre-
tary, Dr. Thomas D. Moore, 899 Madison
Avenue, Memphis, Tennessee, on or before July
1, 1946.”
OPHTHALMOLOGICAL SEMINAR—
EMORY UNIVERSITY
Emory University will celebrate the one hun-
dredth anniversary of the birth of ABNER
WELLBORN CALHOUN, L.D., L.L.D., born
April 16, 1845, died August 21, 1910, the first
professor of ophthalmology of the Atlanta
Medical College.
Your are cordially invited to be the guest
of Emory University at an OPHTHALMO-
LOGICAL SEMINAR to be held in Atlanta,
April 4, 5, 6, 1946.
RESUME PLACES WITH GREENVILLE
CLINIC
The following physicians who have recently
returned from the various battlefronts are
members of the Gamble Brothers and Archer
Clinic staff, Greenville, Miss.:
Dr. E. T. Ellison, captain, Medical Corps,
who served for four years in the South Pa-
cific, is again in charge of obstetrics and
gynecology; Dr. W. H. Cave, captain, Medical
Corps, who saw service on all of the European
battle fronts, is orthopedic surgeon; Dr. B. F.
Hand, colonel, Medical Corps, who spent five
years in New Guinea and the Philippines, is
associated with Dr. J. G. Archer on internal
medicine. Dr. J. G. Marsh is a valuable addi-
tion to the surgical staff. Dr. G. F. Mood,
lieutenant commander in the Navy for your
years, is now associated with Dr. L. S. Gamble
in the eye, ear, nose and throat; and Dr. C.
A. Murry, lieutenant colonel, Medical Corps on
the European front, is in charge of the uro-
logical department.
ANNOUNCEMENTS
A postgraduate course in diseases of the
chest will be given under the auspices of the
Illinois Chapter of the American College of
Chest Physicians at Michael Reese Hospital,
Chicago, Illinois, during the week April 1-6,
inclusive.
Further information may be secured at the
office of the American College of Chest Phy-
sicians, 500 North Dearborn Street, Chicago
100, Illinois.
February, 1946
Deaths
569
The annual meeting of the American Asso-
ciation for the Study of Goiter will be at the
Drake Hotel, Chicago, Illinois, on June 20, 21,
and 22. Please make your hotel reservations
early.
DR. THOMAS E. WILSON
announces
his return to private practice
INTERNAL MEDICINE
and
CARDIOLOGY
Medical Clinic Bldg.
910 North State Street, Jackson, Miss.
• Despite not any man, and do not spurn any-
thing; for there is no man that has not his
hour, nor is there anything that has not its
place.
— Rabbi Ben Azai
That best portion of a good man’s life, -
His little, nameless, unremembered- acts
Of kindness and of love.
— Wordsworth
Deaths
DR. C- A. EVERETT
Dr. Everett died February 8 in the home of his
brother, M. C. Everett, in McComb, where he had
been a guest for a few days.
For forty years Dr. Everett had practiced his
profession, principally, in the Little Springs com-
munity and Bude, both in Franklin County. He was
a graduate of the University of Louisville, Louis-
ville, Ky.
He came to Brookhaven several years ago and
from here went to take a position in the State
Charity Hospital, Laurel. After serving as its super-
intendent, he returned to Brookhaven in 1944. ’•
A native of Amite County, Dr. Everett was reared
in Franklin. He graduated from Mississippi State
College, Starkville, and the medical school of Louis-
ville, Ky. University.
Surviving Dr. Everett are his wife, Mrs. Grace
Rooker Everett, Brookhaven; two daughters, Mrs-
Lexine E. Torrey, Meadville, and Mrs- Lillian E.
Wilson, New Orleans; and a son, Charles A. Everett,
Jr., formerly in the Marine Corps, a student in
Loyola University, New Orleans; two sisters, Mrs.
F. E. Williams, Little Rock, Ark., and Mrs Florence
Adams, Smithdale, and a brother, M. C- Everett of
McComb.
DR. HENRY W. E. WALTER
Dr. Henry W. E. Walther, genito-urinary special-
ist of New Orleans, La., died suddenly January 6 of
a heart attack. A g'raduate of Tulane University, Dr.
Walther had a reciprocity license with Mississippi,
practicing in Gulfport in 1944.
DR. R. G. LADNER
Dr. R. G. Ladner, native Mississippian who prac-
ticed in Purvis and Pascagoula until 1943 when he
moved to Texas, died in Goliad, Texas, January 6,
of cerebral hemorrhage. He was born in Yazoo City,
Miss., in 1887, was educated at Southwestern Uni-
versity, Dallas, Texas.
DR. ANDREW P. McARTHUR
Dr. Andrew Patterson McArthur, prominent phy-
sician in Moss Point, died Wednesday morning at
his residence after an illness of six months- He was
8 3 years old.
A native of Mobile, Dr. McArthur came to Moss
Point about 1914 and had practiced continuously
until his illness forced his retirement last summer-
For the past few years he had made no house calls
but had carried on his office practice.
He was educated in the Mobile public schools
and was graduated from the University of Alabama
and the Mobile School of Medicine.
He is survived by his widow, Mrs. Mary K. Mc-
Arthur; one son, John McArthur; a daughter, Miss
Ella McArthur; and one granddaughter, Mary Day
McArthur, all of Moss Point-
DR. J. C. CARTER
Funeral rites for Dr. J. C. Carter, 57, owner and
operator of Carter Clinic, Magee, were held at Noxa-
pater Baptist Church January - 29.
The members of the Mason Lodge Charley Cockrell
No. 93 had charge of interment in Noxapater ceme-
tary.
Survivors are his wife and daughter, Katharine,
Magee, two brothers of Louisville, one sister of Sa-
vannah, Ga-, and a niece and a nephew of Vicks-
burg.
Pallbearers, E. D. Poneer, W. C- Mangum, G- E.
Burns, Caley Myers, O. J. Biglane, D. M- Yelverton,
J. V. Tuggle, Julius Wells, Wiley Wells and Roy
Jones, all of Magee.
Dr. Carter was born in Chester, S. C., and was
graduated from the University of Tennessee, Mem-
phis, in 1914.
DR- E. G. MARTIN
Dr. Edwin Galtney Martin, 75, promiinent phy-
sician and extensive land owner of Bolivar County,
died at his residence in Benoit February 22, following
a short illness.
Dr. Martin was the son of the late Mr- and Mrs.
James Walker Martin of Rodney. He received his
education at Chamberlain Hunt Academy and was
graduated from the University of Mississippi where
he became a member of the SAE fraternity. His
medical education was received at Louisville Medi-
cal College and Barnes Medical College, St- Louis.
In 1889 he came to Bolivar County and began the
practice of medicine and since that time has con-
tributed to the growth and development of the com-
munity, taking an active part in the life of the
Delta. In 1909 he married Mrs- Cornelia A. Bostick
of Beauford, S. C.
Dr. Martin is survived by his widow, three step-
sons, Roger Bostick, Memphis, Cornelius Bostick,
Greenville and J. A. Bostick, Benoit; four grand-
children, Roger Bostick, Jr., Memphis; Jane and
Cornelia Bostick, Greenville and Mrs. Bill Robertson,
Indianola-
Interpreting; Medica
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health— Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Earl O. Stin-
gily, Meridian.
Pathology — R.. M. Moore, Vicksburg, Miss.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
Ini’ * l ,
DERMATOLOGY
Volume 52, No. 5, November-December, 1945
Pages No. 408, 411, 412.
“Diaper Rash ” Due to Perm-Aseptic. William
L. Dobes, J.A.M.A;, 128:281, (May 26) 1945.
Five cases of diaper rash caused by Perm-
Aseptic are reported. It is used in the last
rinse by diaper services. The purpose is to
make textiles actively antiseptic as a protec-
tion to persons and as a preventive of destruc-
tion of textiles by bacteria, germs, mold and
mildew. Patients wore the diapers treated with
Perm- Aseptic for at least two months before
symptoms of sensitivity appeared.
ISkin Eruptions Due To The Local Appli-
cation of SulphonamiDes. G. A. Grant Peter-
kin, Brit. J. Dermat, 57:1 (Jan.-Feb.) 1945.
The author reports sixty-five cases of light
eruption due to the external application of
sulfonamide drugs. Thirty-two of the patients
had been treated for impetigo; eight for im-
petiginized seborrheic dermatitis; three for
septic infection of the limbs; two for secon-
darily infected tinea of the feet; five for “run-
ing ears” (otitis externa), and fifteen for
wounds and burns of the limbs. In all but four
cases the first sulfonamide drug to be applied
was sulfanilamide powder. It is suggested that
the eruption is invariably, or almost invari-
ably, preceded by application of the powder
and that the patient becomes sensitized to the
drug by its inhalation. It is urged that powder-
ed sulfonamide compounds should not be ap-
plied to the skin for minor conditions.
Over 200 patients, including 183 with im-
petigo or impetiginized seborrheic dermatitis,
were treated in North Africa with five per cent
sulfathiazole in paste of zinc oxide or Lanette
wax cream and the skin freely exposed to
light. Only one patient (with respirator derma-
titis) had the eruption described, but this was
mild and soon subsided. It is considered that
five per cent sulfathiazole in a suitable base
is probably as safe as such drugs as ammoniat-
ed mercury for dermatologic therapy and gives
better results. A comparison is made between
this eruption and other light dermatoses, such
as Hutchinson’s summer prurigo and pellagra.
PEDIATRICS
Herpes Zoster and Chickenpox — Taylor
James, British Medical Journal , 2: 385 (Sep-
tember 22) 1945.
The author says “herpes zoster is a condition
which has excited interest at various times.
It has been noticed to occur in epidemic form.
Some years ago it was believed that second
attacks of herpes never occurred. This view
is no longer upheld.
“Herpes occurs in several regions. The inter-
costal is probably the commonest, and the
cases the writer has met with in children have
all been in this area. It should be mentioned,
however, that the condition is never so pain-
ful in children as in adults, and the post-her-
petic pain so often very troublesome and per-
sistent in the latter is usually slight and of
brief duration in the former. Besides the inter-
costal area almost any other nerve area may
be the site of herpes, such as the shoulder,
the neck, the buttock or thigh and the face.
When it occurs in the face area there is al-
ways danger of affection of the conjunctiva
and subsequent impairment of vision. In one
patient whom the writer saw, three areas were
simultaneously attacked — the face area, the
shoulder area, and the intercostal. This pa-
tient did not recover.
“In 1917 Le Feuvre published a paper deal-
ing with the association of herpes and chicken-
pox, and summed up by urging that herpes,
on account of the close and probably causal
connection between the two diseases, should be
a notifiable disease. In four years he took
notes of seven cases of chickenpox in children
following herpes in a patient. Three of these
570
February, 1946
State Board of Health
571
cases occurred in his own practice, the others
he met with accidentally.
“In an analysis of the cases seen or pub-
lished Le Feuvre notes three classes: (1)
chickenpox in one individual apparently con-
tacted from herpes in another — 41 cases; (2)
herpes in one individual who had been in con-
tact with ia patient with chickenpox — five
cases; (3) herpes and chickenpox occurring
simultaneously in the same individual. He also
mentions several cases in which a parent the
subject of herpes had been warned to look out
for chickenpox in the children. In these oases
confirmation of the justice of the warning
occurred usually in fourteen days.
“Some years ago the writer published a
paper in which he recorded some cases show-
ing the apparent connection between herpes
and chickenpox. In a subsequent paper he re-
turned to the subject, and reference is there
made to several cases communicated to him
by the medical men who had observed them.
In the years that have since passed he had
had several experiences confirming the close
association of the two diseases, and has been
impressed by the fact that very often isolated
vesicles quite indistinguishable from those of
chickenpox will be found in different parts of
the body in patients suffering from herpes. It
was no doubt an extreme case of this nature
which justified Le Feuvre in describing the
third class of these cases — herpes and cliicken-
pox occurring simultaneously in the same pa-
tient.
“There certainly seems to be a strong case
for adopting Le Feuvre’s suggestion for mak-
ing herpes a notifiable disease.”
COMMENT
This is quite an interesting article on the
subject of herpes zoster and chickenpox. We
have been impressed with the idea that herpes
zoster and chickenpox are associated; how-
ever, it is somewhat indefinite even yet, but
it would be well to think of this when we are
confronted with these diseases.
State Board of Health
Felix J- Underwood, M .D.
CONQUEST OF TUBERCULOSIS
Tuberculosis is one of the most serious
public health problems of the state. In 1944
it was the leading cause of death among the
infectious and parasitic diseases. The number
of known cases reported and deaths resulting
for the past few years is a challenge to phy-
sicians and public health workers.
Year
Cases
Deaths
1941
1,445
1,016
1942
1,480
1,092
1943
1,637
887
1944
1,905
813
Mississippi’s Field Tuberculosis Diagnostic
Unit and the local health departments have
done commendable work in case-finding in
spite of innumerable difficulties. Prior to
May 1945 this service had not been too well
organized due to the fact that no definite con-
trol unit assumed full responsibility for all
phases of its program. With federal participa-
tion in tuberculosis control beginning at this
date, the State Board of Health and the super-
intendent of the Mississippi State Sanatorium
worked out a plan for the unification and ex-
pansion of the control program. The plan pro-
vided for setting up a Tuberculosis Control
unit in the Division of Preventable Disease
Control which would have responsibility for de-
veloping greatly expanded case-finding, educa-
tion and local treatment by pneumothorax, all
closely coordinated with the treatment program
of the State Sanatorium and the program of
the state and local tuberculosis associations
and county health departments.
The plan provided for the training of nurs-
ing and medical personnel in tuberculosis con-
trol, the setting up of a central registry of all
known cases, education of the public about
tuberculosis, mass x-ray case-finding by the
use of mobile 70 mm. units, extending out into
every area of the state.
This Tuberculosis Control Unit is now quart-
ered in the Lorenz Building 514J East Amite
Street, in Jackson. Dr. C. C. Smith, formerly
572
State Board of Health
February, 1946
with the Field Diagnosis Unit, will direct this
important work, assisted by Dr. W. C. Redmon,
clinician loaned by the U. S. Public Health Ser-
vice. Miss Miriam Christoph, public health
nurse, Mrs. Winnie Buckels Ray, educator, and
Mr. Armond C. Watts and Mr. Richard B. Le-
foldt, x-ray technicians.
Mobile x-ray equipment designed for x-raying
large numbers of people, using small inexpen-
sive film, is on order and when delivered the
Unit will be ready to function. The x-ray is
an excellent means of detecting early tuber-
culosis and it is hoped that it will be possible
to x-ray every person in Mississippi fifteen
years of age and over and to catch the disease
early when it is amenable to treatment. Since
pulmonary tuberculosis is primarily a disease
of young adults, the case-finding program will
no doubt detect the disease in many unsuspect-
ing and apparently well persons. Experience
of other states with such groups leads to the
speculation that mass x-ray will reveal from
one to two per cent with significant chest dis-
ease.
This new tuberculosis control program is
one of tremendous scope. Its success depends
in large measure upon the full cooperation of
practicing physicians, civic organizations, and
the general public. The eradication of the
White Plague will mean the saving of almost a
thousand lives a year in Mississippi.
.V. ,y. ,y. .v. ,y.
VV VvAvV 7V
TYPHUS FEVER CONTROL
In 1933 there was 1 case of typhus fever re-
ported in the state. None occurred in 1943
but there were 5 cases reported in 1935. Since
that time the number of reported cases of this
disease has steadily increased. In 1942, there
were 59 cases, in 1943 there were 132 cases,
in 1944 there were 178 cases, and in 1945, 228
cases were reported. The disease has appear-
ed in 57 counties of the state; however, the
majority of the cases have occurred in the 35
southern counties.
Since typhus fever of the type present in
Mississippi is transmitted from rat to rat and
rat to man by the rat flea, it is evident that
this disease can be prevented permanently only
by controlling or eliminating the rat which acts
as the reservoir of infection. With typhus
fever on the increase, the State Board of
Health has endeavored to develop a control
program which would be applicable in the exist-
ing county health department organization.
Lack of equipment and personnel has prevent-
ed much progress being made during the past
two years; however, plans are being made to
proceed with such a program as soon as con-
ditions permit.
Typhus fever work needs the cooperation of
an entire community since control of the dis-
ease means control of the rat population of
that community. Besides preventing a dis-
ease which is costly to the victim, elimination
of rats represents an economic saving in the
prevention of food and material destruction
far beyond the cost of control. Because of the
habits of rats, their control is a community
problem and it is on that basis that the State
Board of Health through its Sanitary Engineer-
ing Division hopes to build a program of co-
operative effort embracing all effective means
of rat control. Briefly, these means are:
1. Community cleanup and the installation
of a satisfactory garbage disposal method to
eliminate rat harborages and food for rats.
2. Vent-stoppage of buildings to prevent
the ingress of rats into buildings to secure food
and find harborage.
3. A continuing program of rat eradication
consisting of poisoning and trapping of rats
throughout the entire community.
In an effort to use such means as were
available the Division of Sanitary Engineering
has cooperated with several agencies in assist-
ing a number of cities and towns interested in
this problem. In 1943-1944 in cooperation with
the U. S. Public Health Service a vent-stop-
page and clean-up program was carried on in
the business district of Gulfport under the su-
pervision of the Harrison County Health De-
partment. This city in 1943 had the largest
number of cases of typhus fever ever reported
from a single municipality in the state. The
work undertaken proved effective in preventing
the development of typhus fever in the busi-
ness section of this community.
In January 1945 a control program was
started in Pascagoula in cooperation with the
U. S. Public Health (Service and the Jackson
County Health Department. Both of these
programs proved difficult of execution because
of the shortage of labor land material. Be-
cause of these factors costs were higher than
would be expected under more normal condi-
tions.
As a means of utilizing other resources
available, the State Board of Health cooperat-
ed with the U. S. Fish and Wildlife Service
and the State Plant Board in conducting rat-
killing campaigns in communities throughout
February, 1946
State Board of Health
573
the state. In the fall, winter and spring of
1943-1944 such work was conducted in 59
cities and towns.
In 1944-1945, 62 communities were assisted.
Excellent results were accomplished in reduc-
ing the rat population in these communities
and the number of typhus fever cases appears
to have been lessened. However, it is felt that
unless more comprehensive, permanent and
continuous work is carried on in communities
experiencing typhus fever, the number of cases
in the state will continue to increase.
Since it is an established fact that a reser-
voir of infection exists in the rat population of
the state and that the number of cases of ty-
phus fever is increasing at an accelerated rate,
steps must be taken to develop a broad pro-
gram for the control of this disease to protect
all citizens. All the data available indicate the
disease may establish a firm foothold on the
state and that an increasing number will be-
come victims of its debilitating effects unless
assistance is made available to communities to
fight the spread of infection.
It is far more economical to eliminate and
control enviromental factors causing the spread
of a preventable disease than to try to cope
with the consequences when the disease be-
comes too prevalent and widespread. The peo-
ple of the many communities affected are
showing much interest in control programs
and it is hoped that there will be sufficient
support from the legislature to permit estab-
lishing permanent control procedures against
the spread of typhus and thus protect the
citizens from this unnecessary disease hazard.
*****
Miscellaneous News Notes
Mississippi physicians attending the refresh-
er course in Obstetrics and Gynecology, given
at Tulane University, Department of Graduate
Medicine January 14-18, included the following:
L. H. Brevard, Deeson
W. H. Cook, Philadelphia
E. W. Ellis, Clarksdale
B. B. Harper, Itta Bena
B. J. Hewitt, McComb
C. H. Holman, Carrollton
J. D. Hutchins, Newhebron
S. L. Lane, Hollandale
J. A. Lauderdale, Jackson
C. H. Love, Aberdeen
K. P. Mangold, Greenville
T. R. Ramsey, Laurel
J. F. Simmons, Greenville
W. H. Simmons, Jr., Jackson
R. A. Street, Jr., Vicksburg
W. S. Witte, Leland.
Release of physicians from military service
has made possible the return of several local
health officers.
Dr. R. H. DeJarnette has returned to the
Alcorn County Health Department.
Dr, Warren Jones is Health Officer in Noxu-
bee County.
Dr. Jack G. Young has assumed his duties
as Director of the Marshall County Health De-
partment.
Dr. A. L. Adam is Director of the Pearl
River County Health Department.
PREVALENCE OF COMMUNICABLE DISEASES
IN MISSISSIPPI
Dec.
Dec.
Dec.
1945
1944
5 -Year
Average
Acute Poliomyelitis
7
4
4.2
Bacillary Dysentery
423
441
163.4
Dengue
0
0
0.0
Diphtheria
61
54
45.6
Influenza
22950
6476
16089.6
Measles
445
164
447.2
Meningococcus Meningitis
19
11
12-8
Other Forms Meningitis
10
4
4.8
Pellagra
85
141
149.8
Pneumonia
2368
1736
2185-4
Pulmonary Tuberculosis
104
113
110.2
Scarlet Fever
101
118
91.0
Smallpox
2
0
1.2
Tularemia
5
4
3.8
Typhoid Fever
2
4
4.0
Typhus Fever
20
2
9-4
Undulant Fever
1
2
2.0
Whooping Cough
311
483
579.2
There is still much ahead in the control of
tuberculosis. Mortality reports may give the
number who die, but it is also necessary that
contacts be ascertained to find others who need
medical care or to locate sources of infection
who must be kept apart from the well. In
1943, only thirty-three per cent of the deaths
from tuberculosis in Indiana were reported be-
fore the death certificate was recorded. Many
of those were undoubtedly properly diagnosed
and under care for some time, yet there were
also many whose disease was not recognized
until too late.
There is need for greater recognition of the
problem of the recovery of the aged. Many
are of the chronic type, able to be about, and
therefore more dangerous because of the po-
tentialities of spreading infection to others,
particularly young children. Tuberculosis mor-
tality rates are falling, but in general the per-
centage reduction is much higher in the young-
er groups than among those of older age. Mur-
ray A. Auerbach.
574
Woman’s Auxiliary
February, 1946
Womans Muxiliary
President Mrs- L. J. Clark
Vicksburg'
President-Elect Mrs. Stanley Hill
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Boonerille
Recording Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
RESOLUTIONS
Mrs. J. D. Williams
First President of the Woman’s Auxiliary
to the
Mississippi State Medical Association
Whereas, God in His infinite wisdom has
taken our beloved friend, Mrs. D. J. Williams,
who in the sixteenth year of the Auxiliary
was made honorary president for life, and
Whereas, It was always her pleasure to
present the incoming president of the Auxi-
liary to the House of Delegates on the last
night of the annual meeting, and by her sin-
cere and loving personality inspire her to go
forward with enthusiasm; and
Whereas, We feel that the increasing use-
fulness and influence of the organization have
in no small part been due to her able, wise
and sympathetic leadership and understanding,
and
Whereas, We are moist grateful that she was
spared to us to guide and bless our organiza-
tion to its majority, and
Whereas, We shall sorely miss her steady
hand in our work, but will strive to make our
efforts a loving tribute to her memory, there-
fore
Be It Resolved, By the Woman’s Auxiliary
to the Mississippi State Medical Association,
that in the passing of our first president, the
Association has lost one of its ablest co-
workers and the Auxiliary has lost a comrade
and great leader; and
Be It Further Resolved , That these resolu-
tions be spread on the minutes of the Auxi-
liary, and a copy sent to her beloved hus-
band, Dr. Dan J. Williams.
Mrs. John B. Howell
Mrs. Henry Boswell
Committee on Resolutions
CENTRAL MEDICAL AUXILIARY
The Woman’s Auxiliary of The Central Medi-
cal Society met on February 5, in the home
of Mrs. H. F. Magee, 1520 North State Street.
In the absence of the president, Mrs. George
Riley, who was unable to attend because of ill-
ness, Mrs. A. L. Gray presided.
After calling the meeting to order prayer,
was offered by Mrs. H. C. Ricks.
The roll was called then new members and
guests were recognized and welcomed. The
wives of the doctors, who have returned from
the armed services were heartily greeted.
A very beautiful and fitting tribute was
paid the late Mrs. Dan Williams of Gulfport,
who passed away in January.
(Subscriptions to Hygeia for the junior high
schools and the senior high schools in Jackson
were renewed by the Auxiliary.
On completion of the business session, a
delightful social hour was enjoyed, when the
guests were invited into the dining room,
where a delicious salad course was served by
the following hostesses;
Mrs. H. F. Magee, Mrs. Hardy Hays, Mrs.
Lawrence Long, Mrs. C. E. MacKenzie, Mrs.
T. W. Kemmerer, Mrs. C. B. Mitchell, Mrs. Ben
Walker, Mrs. A. G. Wilde, and Mrs. J T.
Weeks.
The dining table was lovely with an em-
broidered linen cloth and a centerpiece ar-
rangement of red carnations and valentines.
Mrs. C. F. MacKenzie and Mrs. Lawrence
Long poured tea from the silver service.
In the living room there were arrangements
of snapdragons and jonquils.
Mrs. Magee had as her special guests, Mrs.
Henry Easterlin, Mrs. D. B. Sharron, Mrs.
E. H. Galloway, Mrs. Crawford Dennis and
Mrs. J. R. Smith.
Other members and guests present : Mrs.
A. L. Gray, Mrs. P. R. Greaves, Mrs. I. C.
Huggins, Mrs. F. D. Hollowell, Mrs. W. F.
Hand, Mrs. T. H. Blake, Mrs. W. J. Witt,
Mrs. H. C. Sheffield, Mrs. W. A. Smithson,
Mrs. H. C. Hicks, Mrs. T. G. Ross, Mrs. F.
Woman’s Auxiliary
February, 1946
575
A. Donaldson, Mrs. H. C. Denser, Mrs. H.
C. Chustz, Mrs. J. B. Marshall, Mrs. N. O.
Schwein, Mrs. Charles Ward, Mrs. Walter
Simmons, Mrs. John D. Carr, Mrs. W. R. Be-
thea; Mrs. Harvey Garrison, Sr., Mrs. N. R.
Currie, Mrs. Felix Underwood, Mrs. E. D.
Kemp, Mrs. Lee Reid, Mrs. Ray Biggs, Mrs.
J. F. Armstrong, Mrs. Gordon Dees, Mrs. J.
W. Barksdale, Mrs. John Walker, Mrs. William
Noblin, Mrs. Sterling McNair, Mrs. H. F.
Magee, Mrs. J. T. Weeks, Mrs. Ben Walker,
Mrs. Harie Hays, Mrs. L. W. Long, Mrs. C.
F. MaeKenzie, Mrs. T. W. Kemmerer, Mrs.
C. B. 'Mitchell, Mrs. A. G. Wilde, and Mrs.
J. P. Wall.
DOCTORS ENTERTAINED BY
AUXILIARY
If
Doctors in South Mississippi were honored
Tuesday evening February 12 at a dinner
party at Holmes on Highway 11 when mem-
bers of the auxiliary of the South Mississippi
Medical Society entertained in their honor in
celebration of “Doctors’ Day.”
The long dining table, in the shape of a
“T,” held center arrangements of hearts made
of pink perfection and Jarvis red camellias,
ruffled at the edge with tulle and net lace.
White candles burned in silver holders. Place-
cards were handsome lace valentines, and fa-
vors were individual match folders inscribed
with “Doctors’ Day.”
Upon arrival guests were greeted by Dr. and
Mrs. S. E. Bethea and Dr. and Mrs. Earl
Green. They were then directed to an especially
appointed lace-covered table where appetizing
delicacies consisting of shrimp, olives, heart-
shaped sandwiches and tomato juice cocktails
were served by Mrs. J. P. Culpepper and Mrs.
P. E. Smith. Dr. and Mrs. B. D. Blackwelder
presided over the register, which was a large
valentine booklet.
The dinner menu consisted of combination
salad, filet mignon, French fried potatoes, hot
rolls, ice cream and coffee.
The welcome was given by Mrs. Earl Green,
president of the auxiliary, followed by the re-
sponse by Dr. R. E. Schwartz, president of the
South Mississippi Medical Society. A musical
program was presented by Mrs. L. B. Hud-
son, Jr., and Mrs. P. E. Smith. Mrs. Hudson
sang Love’s Old Sweet Song, Where the River
Shannon Flows and Camp Town Races, ac-
companied by Mrs. Smith on the piano. Mrs.
Smith, also a violinist, played Chant and
Puppet Show accompanied by Mrs. Hudson.
Brief talks were given by Dr. Joe Gatlin
of Laurel, and Dr. T. E. Ross of Hattiesburg,
who is a veteran of World War II.
The committee in charge of arrangements
was composed of Mrs. J. P. Culpepper, chair-
man, Mrs. S. E. Bethea, and Mrs. P. E. Smith.
Mrs. W. W. Crawford is chairman of the
committee for the state organization.
Among those attending included Dr. and
Mrs. B. D. Blackwelder, Dr. and Mrs. S. E.
Bethea, Dr. and Mrs. E. W. Green, Dr. and
Mrs. J. P. Culpepper, Jr., Dr. and Mrs. J. A.
Mead, Dr. and Mrs. Nollie Felts, Dr. and Mrs.
P. E. Smith, Dr. and Mrs. R. E. Schwartz, Dr.
and Mrs. Harry G. Fridge, Dr. and Mrs. Law-
rencee B. Hudson, Jr., Dr. and Mrs. T. E.
Ross, Dr. and Mrs. Van C. Temple, Dr. and
Mrs. C. C. Hightower, Sr., Dr. and Mrs. Eu-
gene Busby, Dr. and Mrs. R. H. Clark and
Dr. and Mrs. H. Carroll McLeod, all of Hat-
tiesburg.
Those from Laurel present included: Dr.
and Mrs. G. E. Holder, Dr. and Mrs. Clark
Jenkins, Dr. and Mrs. J. S. Gatlin, and Dr.
and Mrs. Paul Haney. Also present were Dr.
and Mrs. J. N. Mason of Purvis and Dr. and
Mrs. P. D. Hollaway of Collins.
The next meeting of the auxiliary will be
held in March in Laurel.
HOW TO BECOME A WELL-INFORMED
AUXILIARY MEMBER
Subscribe to the Bulletin
Subscribe to Hygeia
All officers use the Handbook
All officers use “Program Outline,” compiled
and sent out by the national program chair-
man.
All the above publications may be secured
by writing the central office:
Miss Margaret Wolfe, Room 410
42 East Ohio Street
Chicago, Illinois.
The ideal life is in our blood and never will
be still. Sad will be the day for any man
when he becomes contented with the thoughts
he is thinkihg and the deeds he is doing,
where there is not forver beating at the doors
of his soul some great desire to do some-
thing larger, which he knows that he was
meant and made to do. - Phillips Brooks.
February, 1946
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Bronchiogenic Carcinoma
ALTON OCHSNER. M.D.*
New Orleans, La.
Primary bronchiogenic carcinoma is one of
the most frequent carcinomas in the body,
representing from ten to fifteen per cent
of all primary carcinomas, and is found in
from one to four per cent of all autopsies. The
incidence of bronchiogenic carcinoma is defi-
nitely increasing as shown by the fact that
the incidence at autopsy has increased within
the past two decades. In the Charity Hospital in
New Orleans in 1931 the incidence of bronchio-
genic carcinoma as determined at autopsy
was 0.47 per cent, whereas in 1940 the incidence
had risen to 3.2 per cent. During the same
period of time the incidence of primary gastric
carcinoma as determined at autopsy varied
very little and remained about 2.5 per cent.
Primary bronchiogenic carcinoma is prin-
we have observed, 86.9 per cent occurred in
cipally a disease of men. In 260 cases which
men and 13.1 per cent in women. It occurs
primarily in older persons as do most car-
cinomas. The eldest patient in our series was
eighty-three years of age and the youngest
was twelve years. Twenty-one and four-tenths
per cent of the patients were in the fifth dec-
ade, 40.8 per cent in the sixth decade, and
24.5 per cent in the seventh decade.
Although one cannot be certain about the
cause of bronchiogenic carcinoma, there is a
good deal of evidence to support the conten-
tion that the increased incidence of primary
bronchiogenic carcinoma is due to the in-
creased incidence of cigarette smoking. There
is a distinct parallelism between the incidence
of primary bronchiogenic carcinoma and the
sale of cigarettes, and probably the chronic ir-
ritation which results from continued, inhala-
tion of cigarettes after years of smoking is a
responsible factor for the development of bron-
chiogenic carcinoma. Professor Roffo, who is
the director of the Institute for Malignant
Disease in Buenos Aires, has also shown that
tobacco contains a tar which has a carcino-
genic effect and that the application of this
tar to the skin and mucous membranes of the
respiratory tract in animals will produce can-
cer.
There are no classical symptoms and signs
of bronchiogenic carcinoma. Because of its
frequency, however, the condition must be
♦From the Department of Surgery, School of Medi-
cine, Tulane University, and the Section on General
Surgery, Ochsner Clinic, New Orleans, La. '
suspected in every man past forty years of
age who has an unexplained thoracic discom-
fort. Frequently there is a history of a pre-
vious respiratory tract infection, such as in-
fluenza, which has not subsided as normally
occurs. There is usually persistent cough, and
not infrequently hemoptysis is present. Wheez-
ing may be only a manifestation. The late
symptoms of bronchiogenic carcinoma are fev-
er, which is usually due to the breaking down
of the growth with secondary infection, and
pain, the latter being the result of involve-
ment of the chest wall. Loss of weight and di-
gestive disturbances are also late manifesta-
tions.
Extension m bronchiogenic carcinoma is
primarily to the regional lymph nodes, and in
most instances a tumor remains localized in
these nodes for a long period of time, permit-
ting a cure in a relatively large group of in-
stances, provided removal of the large nodes
is done at the time the original lesion is treat-
ed.
In the diagnosis of bronchiogenic carcinoma,
roentgenography is of great importance. The
shadow produced by the tumor, if it is large
enough to cast one, is suggestive. Small tu-
mors may suggest an intrabronchial lesion by
producing occlusion to a bronchus with result-
ing atelectasis. In the peripherally located tu-
mors and particularly those involving the up-
per lobe, bronchiography is of great value. Of
greatest importance in the diagnosis of bron-
chiogenic carcinoma is a bronchoscopic exami-
nation, because not only can the bronchoscop-
ist visualize the tumor, but he is also able to
obtain a piece of tissue for microscopic exami-
nation. In some instances, thoracic exploration
is justified in order to make the diagnosis.
There is only one curative treatment for
bronchiogenic carcinoma and that is pneu-
monectomy together with removal of the me-
diastinal lymph nodes. Pneumonectomy has
become a relatively safe procedure and now
carries a hospital mortality rate of about 10
per cent. The curability rate is not so high as
it should be at the present time, because un-
fortunately bronchiogenic carcinoma is not be-
ing diagnosed early enough. Only when the con-
dition is considered as a possibility can the
diagnosis be made early and not until then will
the cure rate in bronchiogenic carcinoma be
high.
577
Several Wartime Therapeutic Advancements
JOSEPH M. MOORE, M D.
Vicksburg, Miss;
As a medical officer in the Army of the
United States during the recent world
conflict, I had the opportunity either to
work with or to observe several therapeutic
advancements. It is intended in this communi-
cation to summarize certain of these agents
and to make brief comments about them. It
must be borne in mind that the views expressed
are personal ones and that no official recog-
nition by the War Department is implied.
BAL
BAL (American terminology for British
anti-lewisite) or DTH (English nomenclature)
is an extraordinary product from England of
known chemical composition. It was evolved
under military secrecy and an antidote against
arsenicals and its formula thereby not dis-
closed. Briefly, the substance is an oil at or-
dinary temperatures with fair stability for one
month if kept in all-glass containers. It de-
composes when boiled or when mixed with
water, but it is miscible and fairly stabile in
organic solvents. The odor is much like that of
hydrogen sulfide. The substance is a direct
nerve poison by any channel of administra-
tion, including that of inunction and the maxi-
mum therapeutic dose for intravenous use is
0.1 cc. A 5 per cent solution in oil has been
issued in the United States Army for intra-
muscular administration.
BAL is a true physiological antidote for the
salts of heavy metals and for many of the
organic combinations of these metals. In the
event of poisoning by such quick-acting war
gas as lewisite (a trivalent arsenical), this
substance will act as a perfect antidote even
if applied to the skin as late as one hour after
the application of fifty minimum lethal doses
of lewisite to the same area; it is quite effec-
tive when used four hours later than the ap-
plication of a lethal dose of lewisite to the
skin. In the event of ophthalmic burns from
this war agent, BAL must be applied much
sooner but, here again, the results are in-
credible as compared to any other treatment.
I have treated some 400 experimental human
lewisite burns with BAL and, in all cases, the
*From the Department of Orthopedics, The Vicks-
burg Hospital, Inc., and Vicksburg Clinic, Vicksburg;
Miss.
prevention of local corrosion and systemic ef-
fects was truly remarkable.
The drug is now recommended as the treat-
ment of choice for exfoliative dermatitis fol-
lowing arsenical therapy in lues. It would also
seem to be the rational antidote for any heavy-
metal poisoning; there seems to be no question
of its superiority over Rosenthal’s reagent
sodium thiosulphate, hydrated ferric hydroxide,
etc. Likewise, work is in progress to determine
if BAL will permit the employment of massive
doses of arsenicals in the treatment of lues.
Sulphacetamide
This is a pre-war modification of sulphanila-
mide by the so-called acetylation of the lat-
ter. The English have always termed the pro-
duct albucid soluble while the United States
Army used the title of sodium sulamyd. The
substance is a white, crystalline solid with
solubility to 30 per cent in water at room
temperatures. It is slowly decomposed by
saline solutions with formation of a yellow
color in the mixture. A 3 per cent aqueous
solution yields a soothing sensation when ap-
plied to the cornea; such a solution has a pH
from 7.3 to 7.4. I am not familiar with any
other aqueous solution of any sulpha prepara-
tion which is not definitely injurious to the
superficial epithelium of the cornea. Large
amounts of this drug were prepared during the
past war for use in the secondary infections
of eye casualties from chemical agents.
The drug, of course, is used under similar
conditions in which one employs sulphanila-
mide. Urologists have used a 30 per cent solu-
tion for lavage of the renal pelvis while the
3 per cent solution can be instilled in the eyes
in ophthalmology practice. Unlike sulphanila-
mide, the drug can be freely sprinkled into
wounds and body cavities without fear of con-
glomerations or foreign-body formations. It has
the advantage of rapid solubility with almost
immediate high bacteriostatic concentration in
the local tissue fluids; this quality is partially
offset by its non-persistence in the field of
application. The two sulpha preparations can
be mixed together in order to secure the ad-
vantages of the parent sulpha preparation and
its offspring or, for topical use, suspensions
of both in ointment bases, methyl cellulose,
etc. have been employed. Theoretically, a blood
March, 1946
Wartime Advancements — Moore
579
concentration of 30,000 mg. per 100 cc. could
be attained by intravenous administration —
the writer has used the drug four times by
such channels without any reaction and with
immediate elevation of the blood level to 15
mg. per 100 cc.
While the United States Army has banned
the routine use of sulphanilamide in clean op-
erative fields, I have employed sulphacetamide
in doses up to five grams prior to closure of
orthopedic procedures in my own practice in
some 200 cases with satisfaction on the theory
that the initial high concentration of the drug
might protect the operative field during its
period of greatest susceptibility to contamina-
tion. There have been no instances of delayed
wound healing, discharge of blood serum, and
like complications as occasionally seen follow-
ing sulphanilamide. In three knee arthrotomies,
I injected one gram of sulphacetamide twenty-
four hours pre-operatively and I was unable
to find any evidence of synovial at the time
of surgery.
Amyl Salicylate
This substance is an oil which boils at 154°
C. and is very stable. The odor is like that of
oil of wintergreen while the color varies from
colorless to deep brown depending upon its
purity of composition. The impure preparations
are satisfactory for use. The substance is in-
soluble in water but is ordinarily used without
dilution. It is applied on the skin only and the
maximum dose is said to be 75 cc. daily. Large
doses give rise to salicylate poisoning. The
vapors are said to be irritating to the eyes
and applications about the genitalia are said
to be contra-indicated; I have not seen any in-
stances of irritation of either area in using
the drug on human burns. The substance will
leave an oily stain on fabrics and it has a pe-
culiar quality of depositing an odor which
clings to such fabrics through several launder-
ings. In clinical use, the drug is generally ap-
pied by means of moistened sponges with over-
lying sheets of oiled silk or cellophane to re-
tard evaporation.
Amyl salicylate was once recommended as an
anti-rheumatic. An allied durg — butyl salicy-
late— proved itself valuable in World War I for
the treatment of mustard gas burns; British
investigators developed the use of the amyl
form for the treatment of gas burns in this
war. The substance has no antidotal bacterioci-
dal, or bacterio-static action, but it does have
great efficiency in preventing or minimizing
edema after chemical burns. I have not been
able to find any satisfactory explanation for
this apparent ability to decrease capillary per-
meability. So far as the power of formation of
crusts or “tanning” be concerned, it is the only
known substance which will tan a mustard gas
burn but this action probably rests upon its
ability to halt exudation from the burn area
rather than upon any coagulating or precipi-
tating reaction. In such burns, conventional
tanners merely float off with the large amount
of “weeping” present, but amyl salicylate, in an
unexplained manner, is quite satisfactory in
arresting such exudates.
While this substance was available to all
English-speaking army personnel for treatment
of chemical burns, I found no instances of its
use for thermal injuries. Theoretically the
drug should be of value in those thermal burns
in which swelling of soft tissues is anticipated.
I have employed compresses of the substance
for five cases of vascular catastrophes of the
lower extremities. Further formation of blebs
did not occur nor was there any infection or
increase in the soggy, water-logged condition
of the cutaneous tissues. Without controls,
these cases are not considered as clinically
significant but it may well be that this drug
may find its place in therapeutics once its
true pharmacological action has been clarified.
Streptomycin
The literature on this drug is already too
voluminous for any detailed account. I have
used the preparation in chronic proteus in-
fections of the soft tissues with much satis-
faction and I have observed the favorable re-
sponses in some seventy-five paraplegics with
pyelo-nephritis to this drug.
Nitrites
Hydrogen cyanide and like substances were
revived during the recent war as possible
casualty-producing agents. It was soon es-
tablished that the conventional antidotes of
sodium thiosulphate and methylene blue had
fair actions as antidotes, but that the nitrites,
in order of their volatility, were the antidotes of
choice. Hence, in cyanide poisoning, the inhala-
tion of amyl nitrite should be the most ef-
fective treatment with intravenous nitroglycer-
ine as the next choice while sodium or cobalt
nitrate would be rated as third choice. I list
this development purely because such a poison,
along with the cyanogens and cyanamides,
are in common industrial and fumigation usage
580
March, 1946
Ludwig’s Angina — Murry
in peacetime with an ever present possibility
of human injury.
Oxidized Cellulose
This substance is included in this report be-
cause of a new wartime utilization — that of
an interposition material in joint surgery. Such
an application was first suggested to me by
Lieut. Col. Robert Carpenter, who noted that
the callus inhibitory factor in this preparation
plasties and excision of joints. Oxidized cellu-
might render the substance useful in arthro-
lose was issued in flat squares, physically like
conventional 4x4 gauze sponges, except for its
increased fragility and brittleness. It con-
tained a thrombin substance and would, on
application to bleeding surfaces, produce an
immediate hemotasis over oozing surfaces or
smaller vessels. The substance is completely
absorbed and does not give rise to adhesions.
I have observed its use in three cases of ex-
cisions of joints and, in each case, a satis-
factory range of mobility was obtained post-
operatively.
iSummary
Several new therapeutic advancements are
briefly described and their clinical applica-
tions partly listed.
NOTE: Chemical and laboratory data cited were
largely compiled from papers on file in the War
Archives, Canberra, Australia, and not available for
publication.
The Modem Treatment of Ludwig’s Angina
Charles M. Murry, Jr. and Gilbert E. Fisher
Birmingham, Ala.
Ludwig’s angina, first described over 100
years ago, is a virulent, rapidly spreading
phlegmonous process arising from infec-
tions within the floor of the mouth or gin-
giva, which is located to a definite anatomic
space. This space has for its floor the mylo-
hyoid muscle, for its lateral walls the bodies
of the mandible, for its posterior wall the
muscles which form the base of the tongue and
for its roof the tongue and mucosa covering
the floor of the mouth. This disease is charac-
terized by severe involvement of the cervical
cellular tissue and profound toxemia.
The original site of infection is usually an
ulcer of the oral mucosa, a carious tooth1
or active gingivitis. The rapidly spreading
cellulitis may assume grave proportions and
menace the life of the patient by producing
severe edema of the larynx and subsequent
suffocation.
The tongue is forced upward toward the
roof of the mouth simultaneously with marked
edema of the mucosa of the floor of the
mouth. Externally there is a tense, non-fluc-
tuant swelling of the soft tissue of the neck
which may extend from the lower border of
the mandible down to the clavicle. This usual-
ly becomes board-like in its rigidity and is ex-
tremely tender on manipulation.
An abscess may be formed which may oc-
cupy one of four possible positions. It may
be found in the potential space between the
muscles of the base of the tongue and the
geniohyoid muscle or it may be observed to
lie at a lower level between the geniohyoid
and mylohyoid muscles on either side of the
median line of the neck.2
The streptococcus is usually found in pre-
dominance although with this organism may
be associated the staphylococcus, bacillus coli
and in some cases gas producing organisms
of the anaerobic type. There is rapid edematous
infiltration of the tissues and the effusion
may be serous, purulent, fibrinous or hemor-
rhagic. Emphysema may be present. In the
early stages pus will not as a rule be found
but rarely does the process become absorbed
under conservative treatment and subside with-
out pus formation.
The course of the disease may be mild for
several days, then suddenly become alarmingly
severe when edema and swelling interfere
with respiration. The temperature, even in the
acute form, may never rise above 99°, but
it is usually of a septic nature ranging between
102° to 105°, accompanied by chills, succeeded
by profuse perspiration. As the disease pro-
gresses the patient becomes increasingly dys-
pneic. Swallowing is excrutiatingly painful
and speech is interfered with. The tongue may
be forced upward to such a degree that its
tip may be forced to protrude between the
incisor teeth.
When a patient presenting the above clinical
picture is seen active treatment must begin
at once. Hot saline irrigations are administer-
ed every two hours. Hot compresses are im-
March, 1946
Ludwig’s Angina — Murry
581
mediately applied to the neck. If the respira-
tion is markedly embarrassed tracheotomy
should be performed. The advent of sulfona-
mide and penicillin therapy has unquestionably
proved to be a great adjunct in the treat-
ment of this disease and chemotherapy should
be instituted as early as possible. Surgical
incision and drainage of the involved area
should be established as early as possible be-
fore this phlegmonous process breaks through
anatomic barriers separating it from the
carotid sheath or mediastinum.
Five such cases have recently come under
our observation and will be briefly reported:
Case I: A fifty-year-old white man was ad-
mitted to the hospital on 1-22-44 complaining
of a severe pharyngitis of 72 hours duration.
The day of admission he developed a marked
swelling in the soft tissue in the floor of the
mouth and neck.
Physical examination revealed a well de-
veloped, well nourished white man in acute
distress with temperature 102°, pulse 90, and
respiration 24. The tongue was greatly
swollen. All of the soft tissues in the floor
of the mouth were edematous and hemor-
rhagic. The soft tissue of the neck was ex-
ceedingly swollen and tense anteriorly and
bilaterally. The pharynx was poorly visualiz-
ed. There was no respiratory embarrassment.
The remaining physical examination was with-
in normal limits. The blood showed 4,820,000
red blood cells with 84 per cent hemoglobin
and 26,750 white blood cells with 92 per cent
polymorphonuclear neutrophils. The urine was
negative.
The patient was given 20,000 units of peni-
cillin at once and then 10,000 units every four
hours. He was given hot saline irrigations to
the mouth every two hours and hot packs
to the neck. 1000 cc. of 5 per cent glucose in
saline were given and repeated in eight hours.
Eight hours after admission the patient be-
came quite dyspneic and slightly cyanotic.
A tracheotomy was performed under local
anesthesia. The next day his general condition
was very poor. The tongue was terribly swol-
len and the tip protruded from the lips. Surgi-
cal drainage of the neck was considered. The
dosage of penicillin was doubled and he was
given two grams of sodium sulfadiazine in-
travenously and then one gram every four
hours. On 1-24-45 a transfusion of 500 cc.
of whole citrated blood was given and in the
evening, under general anesthesia, a trans-
verse incision was made in the submental re-
gion. This was carried through the mylohyoid
and diagastric muscles to the muscles of the
tongue. The tissues were separated widely and
the wound packed open. There was much
edema present but no pus.
On 1-25-45 the sulfadiazine was discontinued.
On 1-26-45 the tracheal tube was changed and
the wound noted to be fairly clean. The patient
was vastly improved but was unable to close
his lips over his tongue. The penicillin was
discontinued after 600,000 units. On 1-28-45
the temperature had dropped to normal. On
1-29-45 the tracheal tube was removed. The
tongue was then back in the mouth and the
patient could breathe well with the tracheal
tube removed. The swelling of the neck had
largely disappeared. By 2-2-45 he was able
to take food by mouth and on 2-3-45 he was
discharged.
Case II. A twenty-seven-year-old colored
woman was admitted to the hospital on 3-30-
45 with a chief complaint of inability to swal-
low. She stated that for one week prior to
admission she had a severe sore throat which
had gradually grown worse. Two days prior
to admission she had difficulty in swallowing
and mild respiratory distress.
Physical examination revealed a well de-
veloped, well nourished colored woman in a-
cute respiratory distress. The temperature was
100, pulse 120 and respiration 28. She had
great difficulty in opening her mouth as the
tongue was elevated forcefully against the
hard palate. The tongue was deeply cyanotic.
The mucosa below the tongue was intensely
indurated but no exudate could be seen. The
neck was extremely swollen and brawny in-
duration founql from the mandible to the cla-
vicles. She was in marked respiratory distress
and soft tissue retraction was present. The
remainder of the physical examination was es-
sentially negative.
On admission the blood showed 3,000,000
red blood cells with 71 per cent hemoglobin
and 20,200 white blood cells with 92 per cent
polymorphonuclear neutrophils. The urine was
negative and the blood Kahn positive.
The patient was given 1000 cc. 5 per cent
glucose in saline containing 2.5 grams of
sodium sulfadiazine at once. This was re-
peated every eight hours, alternating the
glucose in saline with distilled water. 20,000
units of penicillin were given every four hours.
Heat was applied to the neck. During the
evening of admission her respiration became
582
Ludlwig’s Angina — Murry
March, 1946
so labored that a tracheotomy was performed
under local anesthesia and she was then
placed in a steam tent. The next day she was
fairly comfortable and was able to take fluids
by mouth. After the third day she was able
to take one gram of sulfadiazine every four
hours with an equal amount of sodium bi-
carbonate by mouth. The penicillin and sulfa-
diazine were discontinued on 4-5-45. The tem-
perature had returned to normal on the fifth
hospital day. The tracheal tube was removed
on 4-15-45 and no secondary closure was neces-
sary. The patient was discharged on 4-15-45.
Case III: A 20-year-old white woman was
admitted to the hospital 11-7-45 complaining
of swelling 6f the neck and fever for five
days’ duration. Five days prior to admission
a lower third molar tooth was extracted. A
few hours later swelling of the neck de-
veloped accompanied by the onset of fever.
Pain on swallowing the following day and the
fever and swelling increased. Forty-eight
hours prior to admission dyspnea and marked
dysarthria became pronounced and only a
small amount of liquid nourishment could be
taken.
Physical examination revealed a well-de-
veloped, well nourished white woman in ob-
vious distress with temperature 103, pulse 130
and respiration 24. There was no cyanosis and
her respiration was not labored. (She had
difficulty in opening her mouth. The tongue
was red and swollen but was not tender. The
floor of the mouth was edematous. Posteriorly
on the left a small amount of thin purulent
exudate could be seen. The pharynx was poorly
visualized. Anteriorly below the, mandible the
neck was markedly swollen, tender, hot and
board-like in firmness. The remainder of the
physical examination was essentially negative.
The blood count revealed 3,500,000 red blood
cells with 65 per cent hemoglobin and 9,650
white blood cells with 88 per cent polymor-
phonuclear neutrophils. The urine showed three
plus albumin with three to four white cells
and two to three red blood cells per high
power field. The blood Kahn was negative.
She was given 1000 cc., five per cent glu-
cose in saline intravenously and started on
20,000 units of penicillin every three hours.
An initial dose of two grams of sulfadiazine
by mouth was given; followed by one gram
every four hours accompanied by an equal
amount of sodium bicarbonate. Three days of
this sulfadiazine therapy failed to bring the
blood level above 2.6 milligrams per cent; thus
intravenous sodium sulfadiazine was given.
3000 cc. of five per cent glucose were given
daily in distilled water and saline.
Two days after admission her temperature
had dropped to 100°. The swelling was un-
changed although the patient felt much bet-
ter. Fifty hours following dyspnea and cya-
nosis suddenly developed accompanied by a
sharp rise in temperature and it was neces-
sary to perform a tracheotomy under local
anesthesia. Surgery with open drainage was
considered and on 11-10-45 an incision was
made parallel to and 2.5 cc. below the right
mandible. The deep structures of this region
were explored by blunt dissection and a
pocket of purulent material encountered. A
rubber tissue drain was inserted.
On 11-11-45 her condition was only slightly
improved, her temperature 102.2°. However,
general improvement was gradual and on 11-
15-45 the temperature had returned to normal
and the tracheal tube was removed. All
chemotherapy was discontinued on 11-17-45.
On 11-21-45 the tracheal wound was healing
so slowly that a secondary closure was con-
sidered but this was not carried out. On 11-
25-45 the wound was closing nicely and the
patient was discharged. iShe received a total
of 1,500,000 units penicillin.
Case IV : A twenty-two-year-old colored
woman was admitted to the hospital on 11-
25-45 complaining of pain and swelling in the
neck of three days’ duration. Four days prior
to admission a painful right lower third molar
tooth was extracted. Six to eight hours later
fever and slight swelling below the right man-
dible had developed. The swelling rapidly grew
more extensive and spread the opposite side.
For two days prior to admission she had dif-
ficuty in swallowing and could take nothing
but fluids in her mouth. This was accompanied
by slight difficulty in breathing.
Physical examination revealed a well devel-
oped, well nourished colored woman in acute
distress. The temperature was 102°, pulse 100
and respiration 20. She was able to open her
mouth only about half an inch and the pharynx
was poorly visualized. The tongue was mark-
edly elevated and dysarthria had developed.
There was bilateral tenderness on palpation
along the floor of the mouth. There was no
induration under the tongqe and no visible
March, 1946
Ludiwig’s Angina — Murry
583
exudate in the mouth. The neck, anteriorly
below the mandible, was markedly swollen
bilaterally, and exceedingly tense on palpa-
tion. The remainder of the physical exami-
nation was within normal limts.
On admission the blood showed 3,510,000
red blood cells with 61 per cent hemoglobin
and 31,350 white blood cells with 92 per cent
polymorphonuclear neutrophils. The urine
showed a slight trace of albumin and the
blood Kahn was negative.
The patient was placed on a liquid diet as
tolerated; hot saline irrigations to the mouth
and was given 1000 cc. five per cent in saline
containing 2.5 grams of sodium sulfadiazine.
One gram of sulfadiazine every four hours
with an equal amount of sodium bicarbonate
was given orally. The following day penicillin
therapy was begun (20,000 units every three
hours). Her temperature at this time was
103°. On 11-27-45 wide surgical drainage was
carried out. An incision was made on each
side of the neck about 2.5 cm. below and
parallel to the mandible. The fascial planes of
the neck were explored and purulent material
encountered on each side. Rubber tissue drains
were put in place. The drainage had a very
foul odor.
On 11-28-45 the temperature was down to
100° and the patient’s general condition was
improved. The sulfadiazine and penicillin were
continued postoperatively. On the fifth post-
operative day her temperature was normal.
All medication was stopped on 12-3-45 and on
12-8-45 the patient was discharged. At the
time of her discharge there was still a slight
amount of induration near the angle of each
mandible. She received a total of 1,160,000
units of penicillin.
Ca^e V : A forty-nine-year-old colored man
was admitted to the hospital on 42-13-45 com-
plaining of inability to open his mouth. Six
days prior to admission a right lower molar
tooth had been extracted. Forty-eight hours
following this operation the lower right jaw
began to swell and become tender. This grad-
ually spread to the other side and became
more extensive, causing dysphagia. The pa-
tient had experienced no respiratory difficulty.
Physical examination revealed a well devel-
oped, well nourished middle aged colored man
in moderate distress. The temperature was
101.8°, pulse 100 and respiration 20. He was
able to open his mouth only slightly. The
tongue was noted to be greatly swollen and
protruded slightly through the incisor teeth.
There was slight induration beneath the
tongue along the floor of the mouth and the
mouth was noted to be extremely dirty. The
pharnyx was very poorly visualized. The neck
anteriorly was firm, non-fluctuant, hot and
tender below the mandibles on either side. The
remainder of the physical examination was
within normal limits.
On admission the blood showed 3,000,000
red blood cells with sixty-one per cent hemo-
globin and 9,600 white blood cells with eighty-
eight per cent polymorphonuclear neutrophils.
The urine examination was negative. The
blood Kahn was negative.
Chemotherapy was instituted consisting of
20,000 units of penicillin every three hours
and 1000 cc. five per cent glucose in saline
containing 2.5 grams of sodium sulfadiazine
and an equal amount of sodium bicarbonate
every eight hours; The patient was given hot
saline irrigations to the mouth every three
hours when awake and heat was applied to
the neck.
Within twenty-four hours the temperature
was normal and with the exception of a sharp
rise up to 101 on the sixth hospital day, re-
mained within normal limits. On 12-15-45
there was very little change in the general
appearance of the patient, although he stated
that he felt much better. The tongue had
receded and the patient was able to open his
mouth more than on admission.
On 12-17-45 a culture was taken of the
purulent exudate from the floor of the mouth
and on 12-20-45 a report of hemolytic strep-
tococcus viridans was received. By 12-23-45
the patient was able to take adequate fluids
by mouth and the intravenous fluids were
discontinued. The penicillin and sulfadiazine
were discontinued on 12-25-45.
On 12-31-45 the patient was feeling fine
and very anxious to go home. There was
still some slight induration along the angles
of the mandibles at the time of discharge
on 12-31-45.
SUMMARY
1. Five cases of Ludwig’s angina are re-
ported, three of which were of dental origin.
2. All cases were treated with combina-
tions of sulfadiazine and penicillin. The first
two cases were given 20,000 units of penicillin
584
Hypotension — Purks
March, 1946
every four hours, whereas the remaining three
were given the same dosage every three
hours. The change in administration of peni-
cillin from every four to every three hours
was based on the fact that studies have shown
that the concentration in the blood reaches
its maximum about fifteen to twenty minutes
after administration and falls rapidly so that
eighty per cent appears in the urine within
two hours.
REFERENCES
1. Furatenberg, A.C. : Acute Suppurations of Throat,
Mouth and Cervical Region. Reprint from Transac-
tions of Twenty -fourth Annual Meeting, Pacific
Coast Oto-Ophthalmological Society, p 3-
2. Blassingame, Charles D- : Angina Ludovici, An
Anatomic and Clinical Study, Arch. Otolaryng- 1928
8:159.
3. Factors Determining the Dosage of Penicillin in
the Treatment of Infections. The Bulletin of the
U. S. Army Medical Dept. Vol- IV, No- 2, August,
1945, p 181.
Postural or Orthostatic Hypotension
w. K. PURKS, M.D.
Vicksburg, Miss.
It has been very aptly said that “There is
hardly a condition in the field of medicine
that disturbs the patient or affects his gen-
eral morale as much as does the loss of con-
sciousness, or a severe attack of vertigo.”1
Postural hypotension is such a disorder, and
for this and other reasons deserves our con-
sideration. Typical cases of idiopathic ortho-
static hypotension tare relatively rare. Prior
to 1940 not more than 50 such cases had been
reported.2 We must, however, constantly bear
in mind that varying degrees of orthostasis
are seen in many disorders and will be of
great importance in the consideration of many
patients.* 3 It cannot be too strongly empha-
sized that in all disorders associated with loss
of consciousness or of extreme dizziness the
physical examination cannot be considered
complete until the blood pressure has been
recorded in the upright or standing posture.
No doubt many patients who bear the un-
pleasant stigma of epilepsy do in fact have
orthostatic hypotension, a condition in which
treatment offers good prospects of sympto-
matic relief.
Time does not permit a complete discussion
of the syndrome of orthostatic hypotension.
I wish, however, to review the salient features
of this syndrome, as first described by Brad-
*Read in part before Southern Sectional Meeting,
American Federation of Clinical Research, December
4, 1943.
bury and Eggleston4 in 1925, to suggest those
conditions in which orthostasis is most often
seen as a temporary or symptomatic finding,
and finally to present briefly a case that il-
lustrates the idiopathic variety.
The features of idiopathic hypotension as
described by Bradbury and Eggleston are as
follows :
1. Marked fall in blood pressure and occur-
rence of syncopal attacks when the patient
assumes the upright posture.
2. Slow pulse which does not change with
posture.
3. Increased distress during the summer
months.
4. Anhydrosis, or hypohydrosis.
5. Slightly lowered metabolic rate.
6. Slight or indefinite changes in the central
nervous system.
7. Slight elevation of the blood urea nitro-
gen.
Some additional, though less constant, find-
ings are:
1. Greater urine output during the night.
2. False or unusual appearance of extreme
youth.
3. Pallor or secondary anemia.
It is unlikely that every case will show all
of the above mentioned features. The really
critical finding is the change in blood pressure
with the assumption of erect posture. The
pulse rate has in some instances been sharply
March, 1946
Hypotension — Purks
585
elevated as the blood pressure falls. In fact,
MacLean and Allen5 have seen fit to describe
two syndromes: 1) orthostatic hypotension
and, 2) orthostatic tachycardia. The latter
condition is practically identical with the for-
mer, except that the fall in blood pressure is
less marked, apparently because of the rapid
heart action which results in partial compensa-
tion. The increase of symptoms during hot
weather is a rather common feature. In this con-
nection it is of interest to note the studies of
Kopp9, who found that patients who received
fever therapy show orthostatic phenomena
which persist for a time after body temperature
has returned to normal. These changes are con-
sidered due to impairment of vascular tone and
poor tone of the skeletal musculature, especial-
ly of the abdomen and legs, resulting in pooling
of blood in dependent areas. No doubt, the
same mechanism is a factor in idiopathic hy-
potension. The lack of sweating or diminished
sweating in these patients is considered an
evidence of impaired sympathetic function. At
present, most evidence points to impaired
sympathetic function, either central or per-
ipheral, as the mechanism responsible for or-
thostatic hypotension. Stead and Ebert7, after
careful experimental studies of three patients,
concluded that these patients did not in fact
pool an abnormal amount of blood in the
legs, but that reflex vasoconstriction which
maintains the normal blood pressure in normal
subjects under similar conditions does not oc-
cur in patients with orthostatic hypotension.
This loss of reflex vasoconstriction is respon-
sible for a fall in blood pressure and is the
fundamental disturbance in postural hypo-
tension, and distinguishes it from other types
of poor functional adaptation. MacLean and Al-
len, although granting the importance of lack
of vasoconstriction as a factor in orthostatic
hypotension, feel that the fundamental mechan-
ism is an inadequate venous return to the
heart. This has been demonstrated by the
Flack test, which consists of having the sub-
ject exhale against an unyielding resistance,
thereby increasing the pressure against the
veins in the thorax. This results in syncope,
and x-ray at this time will demonstrate a de-
crease in heart size. In practice the test is
performed by having the patient blow against
the column of mercury in the sphygmomano-
meter. Normal subjects can sustain forty milli-
meters of mercury pressure for twenty seconds.
The individual with orthostatic hypotension
develops syncope within ten seconds.
Now let us briefly list some of the conditions
in which orthostasis frequently is observed, al-
though the patient may not fall into the group
of idiopathic hypotension. Most of these dis-
orders are associated with poor muscle tone,
inadequate venous return, or possible damage
to the autonomic nervous system, either cen-
tral or peripheral: 1) myasthenia gravis, 2)
Addison’s disease, 3) heat exhaustion, 4) pro-
longed bed rest, 5) following prolonged toxic
or infectious agents, 6) head injuries — post
concussion syndrome, 7) tabes dorsalis, 8)
Simmonds disease, 9) spinal cord lesion, 10)
following surgical sympathectomy, and 11)
in psychically inferior individuals.
Some comment should be made regarding
the treatment. Spontaneous remissions are
common. The treatment of the idiopathic
variety differs from that of the symptomatic
variety only in the necessity for removal of
the causative factor if possible in the latter
condition. A great variety of drugs have been
used, and reports of successful treatment
with ephedrine8, benzedrine9, and paredrine19,
and neosynephrin n are frequently seen.
In each of these the relief obtained occurs
only when the blood pressure is raised to
such a degree that the level of blood pres-
sure following postural change is above the
syncope level. The mechanism of the blood
pressure fall is not abolished. Other drugs,
such as anterior pituitary and adrenal corti-
cal substance, have been tried with varying
success. It now appears, however, that the
only treatment which may abolish the abnor-
mal mechanism is the so-called “Heads-up”
treatment, reecommended by MacLean. This
consists simply of having the patient sleep
with the head of his bed elevated eighteen
inches. This method has been almost uniform-
ly successful in pure orthostatic hypotension,
in orthostatic tachycardia, and in many in-
stances of symptomatic orthostatic hypoten-
sion.
CASE REPORT
E. E. R., male, age 20, was first seen
on June 26, 1942, complaining of attacks of
unconsciousness of ten years’ duration.
His family history was negative except that
his father had an overactive carotid sinus
reflex and suffers attacks of syncope.
His past history indicates that at the age
of eighteen months he fell from a bale of
cotton and struck his head and was momen-
tarily unconscious. His childhood subsequently
586
Hypotension — Purks
March, 1946
was uneventful except for rather poor pro-
gress in school. At the age of ten years he
began having the attacks referred to in his
complaint. He consulted several physicians and
in 1935 a definite diagnosis of epilepsy was
made.
Present Illness: At the age of ten years he
had his frist attack of unconsciousness. Sub-
sequently attacks have occurred at frequent
intervals. There has been no aura preceding
the attacks. The attacks have never occurred
in the recumbent posture nor at night. He
has had no convulsive movements and has
never bitten his tongue. Most attacks occur
in the early morning hours and have been
distinctly worse in the summer months. The
usual duration of unconsciousness is one to
two minutes, always relieved when he falls
to the floor or is placed in the recumbent
posture.
Physical examination showed no abnormali-
ties except those related to blood pressure
and his pulse. These will be detailed later.
There appeared to be somewhat less than a
normal amount of perspiration. Carotid sinus
pressure disclosed no abnormal response. The
heart size is normal. Electrocardiogram in re-
cumbent posture showed normal curves. Elec-
trocardiogram in upright posture showed
tachycardia, rate 125, slight shift of the axis
toward the right, and an inverted T-wave, in
the third lead. Routine blood and urine studies
were; negative. X-ray of the skull was nega-
tive., X-rays of the kidney area showed no ab-
normal calcification.
His blood pressure changes were as follows:
Date
Medication
Hr.
Recumbent
Upright
Symptom
6/26
Noie
4:00 P.M.
110/77
0
Dizzy
6/27
Benzedrine
»
6/28
Benzedrine
8:00 A.M.
110/60
0
Dizzy
1:00 P.M.
115/60
0
Dizzy
6/29
3:15 P.M.
118/64
0
Dizzy
Cort. ext.
8:00 A.M.
110/60
0
Dizzy
Cortalex
12 noon
110/50
0
Dizzy
6/30
t. i. d.
5:30 P.M.
110/54
110/80
Stable
Cortalex
1:00 A.M.
110/40
0
Dizzy
7/1
t. i. d.
10:30 A.M.
116/54
0
Dizzy
Cortalex
9:00 A.M.
110/48
78/58
Dizzy
t. i. d.
10:30 A.M.
114/64
0
Dizzy
7/2
3:20 A.M.
108/40
94/78
Stable
Cortalex
8 A.M.
108/40
90/50
Stable
t. i. d.
12 noon
110/40
108/60
Stable
2 P.M.
114/48
98/48
Stable
In the recumbent posture the blood pressure
was 110/78, and the pulse 72. Upon assuming
the upright posture he became dizzy; the pulse
increased to 140 per minute, and his blood
pressure became too low to record. He was
returned to recumbent position before syncope
developed. This sequence of events was re-
peatedly observed on the date of the first ex-
amination. The patient was then started on
benzedrine, in doses of five milligrams, three
times daily. This drug caused nervousness
and did not correct the blood pressure changes,
so that it was discontinued in forty-eight
hours. The patient was then given ten cc. of
adrenal cortical extract at 10:30 A.M. on
the third day, and subsequently received one
tablet of adrenal cortical extract by mouth
three times daily. Within three days he was
able to tolerate the upright posture, and al-
though his blood pressuse still showed a fall
in the upright posture, he had only slight
dizziness and was permitted to leave the hos-
pital. During the subsequent months he had
no trouble so long as the cortical extract was
taken, and later in the winter he discontinued
all medication. During the summer of 1943
he had an occasional attack of dizziness, but
has not sought medical advice. He was advised
to elevate the head of the bed, and although
readings of his blood pressure have not been
made, it may be assumed that he is doing
satisfactorily, as he has been enlisted in the
Army as a paratrooper for the past year.
Differential Diagnosis of Nasal Allergy*
D. W. HAMRICK, M.D.
Corinth, Miss. . .
It’s not ashes to ashes, but dust to dust
Or molds, or pollens, or maybe rust;
Strange as it seems it’s indubitably true
The inevitable allergy betwixt earth and you.
Before the days of Emily Post the stain so
often seen on the proverbial coat-sleeve may
have been due to nasal allergy. In the field
of otolaryngology ten years ago we have all
heard the statement that the number of hand-
kerchiefs a patient used per day was a diag-
nostic criteria of nasal sinusitis. Today I would
say emphatically that it is far more indica-
tive of nasal allergy.
In a review of 720 patients complaining of
nasal symptoms Kuhn1 found that approxi-
mately 20 per cent had definite nasal allergy.
Opheim2 in a study of a large number of pa-
tients concludes that 25 per cent of all pa-
tients with nasal symptoms are found to be
allergic. Baum3 found that out of 7000 pa-
tients with nasal complaints, 191, or 27.3 per
cent, proved to be allergic. Hansel4 in a
review of 324 patients with nasal complaints,
found that 142 had manifestations of nasal
allergy, or approximately 24 per cent,
had manifestations of nasal allergy, or ap-
proximately 24 per cent.
A perusal of the literature shows conclusive-
ly that approximately 20 to 25 per cent of
patients coming to us with nasal symptoms are
definitely allergic. It is this group of patients
who are constantly seeking relief at our of-
fices day after day. In the past we have spray-
ed them, packed them, tried all the new nose
drops on them, used escharotics on them, and
prescribed for them with little or no relief of
distressing symptoms. In fact we have made
most of them worse. The one plea that is
made in this presentation is a better diagnos-
tic study of this group of unfortunate pa-
tients.
The child who has a continuous cold and a
“runny” nose is a suspicious case, and should
have allergic investigation. When a mother
says her child takes “cold” every time Ait
sticks its head out of the house, the answer
may well be allergy. Val
♦Read before the joint meeting the Northeast Mis^*7
sissippi and North Mississippi medical societies,
University, Miss., March 12, 1946.
Polyposis in the opinion of Kern and
Schenck5 is always an evidence of nasal al-
lergy.
The so-called chronic sinus patient accord-
ing to Arbuckle6 has an allergic background
in well over 50 per cent of the cases.^ v
The work of Woodward and Swinefordt
shows about this same percehtag%£|ofP allergic
background.
ifc. : m : ' ?
The so-called vasomotor rhinitis, apd many
of the dry stuffy noses are found to • be al-
tergie. ...iis Z
A family background for nasal ’ allergy i&
found in only 60 to 70 per cent of the eases.
Past and present history of allergic symptoms
are found in about 85 per cent of adults, and
about 70 per cent of children according to
Hansel.8
- ^ !
In the differential diagnosis of nasal allergy
the past history of being a “collicky” baby,
past history of eczema, or urticaria are infan-
tile indications of allergy. The onset of al-
lergic symptoms^ may date from the acute in-
fectious diseases of childhood or acute upper
respiratory infections. The frequency, dura-
tion and onset of attacks are important. The
place of residence, occupation, climate, environ-
mental contacts, the season of onset and its
effect on the symptoms must be considered.
Also a careful diary of all foods eaten is neces-
sary.
A careful history is often almost conclusive
in making a correct diagnosis.
The appearance of the nasal mucous mem-
brane and the size of the turbinates varies in
direct proportion to the edematous involve-
ment present. The color of the membrane may
vary from normal, slightly pale, markedly pale
or edematous, to red according to Jones.9
Nasal polypi always indicate nasal allergy.
The appearance of the nasal mucous membrane
and its adnexa is not conclusive evidence of
nasal allergy per se.
The point of emphasis that I want to leave
iin this discussion is the microscopic examina-
tion of nasal secretion from every patient a-
cute, or chronic whoi is having nasal symp-
587
588
Nasal Allergy; — Hamrick
March, 1946
toms. The specimen is taken by having the
patient blow his or her nose on a piece of or-
dinary waxed paper. Make a smear of the
thicker parts of this secretion on an ordinary
microscopic slide.
The smear is then fixed and stained for
eosinophiles. The most distinctive , stain for
this is Hansel’s, Geimsa’s or Wright’s blood
stains may be used, but they are not nearly
as dramatic in bringing out the eosinophiles.
In a routine examination, of nasal smears from
eighty-eight cases of nasal allergy, Kuhn
found that twenty-six showed an eosinophilia
of over 50 per cent, thirty-four varied from 10
to 50 per cent eosinophiles, and twenty-eight
showed an eosinophilia of from 1 to 10 per
cent of all cells. The presence of any eosino-
philes in this secretion is certainly suspicious
of an allergic tissue reaction. In bacterial in-
fections the stained nasal smears show almost
100 per cent neutrophilic cells. There are many
variations in the miscroscopic picture vary-
ing from almost 100 per cent eosinophilia in
purely allergic nasal secretions to only streaks
and clumps of eosinophiles in the mixed in-
flammatory secretions.
X-ray and transillumination in many of our
nasal cases is still a necessary part of our
diagnostic study. “Roentgenographic changes
in the sinuses of allergic noses are found to
vary from simple edema to extreme polypoid
thickening. “K) Transillumination and its in-
terpretation depends entirely on the experi-
ence and clinical interpretation of the opera-
tor. The usual picture in nasal allergy is one
of general haziness of all sinuses, varying ac-
cording to the amount of edema present.
Skin testing is very reliable in the inhalant
group of allergens running about 80 to 95
per cent positives, but a negative skin reac-
tion does not rule out nasal allergy. Skin test-
ing with the food allergens is not conclusive,
and can be ruled out only by an elimination
diet.
In a patient with nasal symptoms in whom
the evidence is not conclusive of nasal allergy
from the fore-going studies, one is justified
in doing a therapeutic test. This consists in
giving a subcutaneous dose of 0.10 cc. to 0.20
cc. of a 1:10,000,000 dust extract. If there
is a marked improvement in nasal symptoms
lasting for several days the patient should be
given complete skin test study.
The examination of smears of nasal secre-
tions is one of the most neglected of all nasal
examinations. A wider recognition of nasal
allergy in the treatment of nasal symptoms
will bring the patient untold relief, and save
a lot of unnecessary and mutilating nasal
surgery.
REFERENCES
1. Kuhn, H. A- : Allergy in Ear, Nose and Throat
Practice. Jour. Ind. State Med. Ass’n. 32:241, 1939.
2. Opheim, O. F. : Allergic Diseases of the Nose
and Sinuses. Nord- Med. tidskr. 16:1607, 1938.
3- Baum, H. L. : _ r; Incidence of Allergy to Rhi-
nologle Practice Arch. Otolaryng. 20:804, 1934.
4. Hansel, H. K. : Allergy of the Nose and Paran-
asal Sinuses, pp 423.
5. Kern, R. A-, and Schenck, H. P. : The Diagnosis
and Treatment of Mucous Nasal Polyps, with con-
sideration of the Allergic Factor. Med. Clin. N.
Amer, 22:1633, 1938.
6. Arbuckle, M- F- ; End Results of External Opera-
tions on the Frontal, Ethmoid and Sphenoid Sinuses,
Arch. Otolaryn. 30:736, 1939.
7. Woodward, F. D., and Swineford, O. : Allergic
Rhinitis etc- Erch. Otolaryn. 34:1123, 1941.
8. Hansel, F. K. : Allergy of the Nose and Par-
anasal Sinuses, pp 422.
9- Jones, E. H. : Allergic Rhinitis, South. Med-
Jour. 32:647, 1939.
10. Hansel, F. k. • Allergy of the Nose and Par-
anasal Sinuses, pp 415.
There is still much ahead in the control of
tuberculosis. Mortality reports may give the
number who die, but it is also necessary that
contacts be ascertained to find others who
need medical care or to locate sources of in-
fection who must be kept apart from the
well. In 1943, only 33 per cent of the deaths
from tuberculosis in Indiana were reported
before the death certificate was recorded.
Many of these were undoubtedly properly
diagnosed and under care for some time, yet
there were also many whose disease was not
recognized until too late.
Roseola Infantum
J. L. Rubel, M. D.
Columbus, Miss.
Roseola infantum is a specific disease, al-
most exclusive in infancy, characterized by
unexplained fever and later the appearance
of an exanthem.
Numerous terms have been used in the past
to describe this condition, namely, roseola in-
fantum, exanthem subitum, exanthem criti-
cum, pseudo rubella, sixth disease and rose
rash of infants, the more common in current
usage being roseola infantum and exanthem
subitum.
It was first described in 1910 by Zahorsky
and again in 1913 by Veeder, Hempelman,
Levy and Westcott in 1921. Veeder and Hem-
pelman first comprehensively described the
hematological changes so characteristic of in-
fantile roseola.
The disease is both widespread and com-
mon, having been reported all over this con-
tinent and in foreign countries. From this
report on observations on thirty-two proved
cases in private practice, it may be seen that
the illness does not exclude the South in its
distribution.
Most cases occur in the spring and autumn
months, but sporadic cases may develop
throughout the year. Both sexes are about
equally susceptible.
Age is a very important predisposing fac-
tor. One hundred per cent of my admittedly
small series of cases were below the age of
eighteen months and it may be safely said
that above 95 per cent of cases occur before
two years of age. Cases of seven, nine and
even fourteen years have appeared m the
literature but these are extremely uncommon.
The etiology is unknown; since the disease
is never fatal, no pathological series of cases
have been described. Most students of the
disease feel that it is a virus infection but
isolated cases are the rule; isolated epidemics
in institutions have been reported. The dis-
ease may be said to be mildly contagious and
therefore infectious.
Symptomatology may be quite varied in
this age group of patients but fever and rash
are always present in the course of the dis-
ease. The disease is usually ushered in by
a
n *Read before the joint meeting the Northeast Mis-
sissippi and North Mississippi medical societies,
University, Miss-, March 12, 1946.
the onset of sudden fever, the infant having
been quite well and cheerful. This fever con-
tinues, usually typhoidal and occasionally in-
termittent in type, for two to five days, after
which it falls by lysis or crisis, the exanthem
soon appearing . This is the classical descrip-
tion of roseola infantum. The fever usually
runs from 100.5° to 104° F., but may be
normal at times during the febrile course or
even 108° F. when febrile convulsions ensue.
As the fever continues, the infant usually be-
comes drowsy, is quite irritable, refuses food,
usually sleeps a great deal and either stays
to his bed or wants to be held continually.
Sleepless nights are the rule when the fever
climbs and convulsions and resultant stupor
may occur. Vomiting and diarrhea may be
present.
Physical examination in the first twenty-
four to thirty-six hours of the disease reveals
nothing. The baby is quite ill and the only
positive finding is fever. Recourse to the
laboratory on this or third day may throw
light on the condition. Urine, spinal fluid,
blood culture, blood agglutinations and stool
cultures are quite negative, but usually there
is a leucopenia which in one case was as low
as 2,000. Usual figures are 3,500 to 6,000.
Coupled with this leucopenia, there is a lympho-
cytosis which. extreme and in several
cases was found to, be above 90 per cent. This
leucopenia and lymphocytosis is quite charac-
teristic of the disease when present.
As the illness progresses, the cervical
lymph nodes may enlarge slightly and a few
cases show a very mild pharyngitis, tonsil-
litis, catharrhal otitis media and injected con-
junctivae. A cough may be present but is
never severe. Recently attention has been
called to erythematous dots and streaks on
the soft palate which, when present, are said
to be pathognomonic of the disease. Many
cases occur during the season of coryza, which
may be present and confuse the diagnosis.
The final and completely diagnostic phase
of the disease is the eruption, which comes
usually as the temperature falls to normal,
but which may be delayed as long as twelve
to twenty-four hours. Patients are rarely
seen in whom the fever extends for eight to
twenty-four hours sifter the appearand of
{Continued to page 592) ^ >iT9£I0
589
590
Editorials
March, 1946
The Mississippi Doctor
Published monthly at Booneville, Mississippi.
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
W. H. ANDERSON, M.D. Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M. D Vice-President
El Dorado, Ark.
A. F. Cooper, M. D Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M- D Director of Exhibits
Memphis, Tenn.
E. M. Holder, M. D. C. R. Crutchfield, M. D.
F. M. Acree, M. D. H. King Wade, M. D.
Lawrence W. Long, M-D.
J G. Archer, M.D. W. Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M.D., Suite 412 Standard Life Building,
Jackson, Mississippi.
LEGISLATURE APPROVES MEDICAL
SCHOOL
Enabling acts for a four-year medical school
in Mississippi have passed both houses of our
legislature. It is thought that appropriation of
funds will be made to make the school a reali-
ty at a reasonably early date and along with
the school we trust we may have a system
of affiliated hospitals that will be a great
means in giving the very best medical service
to our people that is offered in this nation.
It seems now that Mississippi is on the way
with the best medical service system of any
state in the union. It is true that we have
quite a distance to travel, but the way is
open. We have the green sign. The four-year
medical school must go hand in hand with
our affiliated hospital system if our state is
to be set apart in leadership for medical ser-
vice. Mississippi took the lead for the masses
when she established the per capita distribu-
tion plan for the indigent sick. This amount
has now been increased and the pay per day
to the hospital has increased from $2.50 per
day to $4.00 as we encouraged in the begin-
ning.
We must train young interns and nurses
in part at least in the smaller hospitals of
the state if we are to have doctors and gradu-
ate nurses who will remain in Mississippi and
know how and will be willing to render ser-
vice.
If Mississippi now lives up to her oppor-
tunities she will be a beacon light in medical
service for our state, for our nation and the
nations of the earth. Let us catch the vision,
let us have the courage, let us work in a
brotherly fashion to meet a great challenge,
that of carrying the best in medicine to all
the people. The will of the medical profession
should be that none shall perish, but that all
shall have service that gives and prolongs
human life.
THE STATE MEETING
Get your reservation now for your state
meeting at the Robert E. Lee Hotel in Jack-
son, beginning May 14. Let us make this
meeting one of our best. Dr. Crawford of
Tylertown is president and Dr. Avent of Gre-
nada is president-elect.
May is just around the comer. Make your
plans now to attend the meeting. Let us
make it a good one.
NEW ORLEANS GRADUATE ASSEMBLY
During the “duration” the doctors of New
Orleans had the vision to keep their Graduate
Medical Assebly going right along. They had
the ingenuity to secure rooms for the doctors
who wished , to attend. The medical schools
of New Orleans have done much also to keep
medical information in liquid form and flowing
along without being rationed or hampered.
New Orleans is a great medical center; it has
been for years and it is growing at a rapid
rate. America’s most interesting city, it also
has friendly people and a cosmopolitan air. The
Assembly this year was extraordinarily fine.
March, 1946 News and Comment 591
Congratulations to the progressive spirit of
New Orleans medicine.
GROUPS CONSOLIDATE
The first quarterly meeting of the North-
east Mississippi Thirteen Counties Medical So-
ciety was held in conjunction with the North
Mississippi Six County Society on the Ole
Miss campus on March 12. Dr. Whitaker, presi-
dent of the North Mississippi Six-County
Society, presided over the meeting. Dr. J. Rice
Williams was absent to the deep regret of all.
Members of both societies seem to be a hun-
dred per cent in favor of consolidation. The
only question raised was of the meeting place.
For the benefit of the medical school at Ole
Miss, it was decided to have two of the four
meetings at Ole Miss. This would hold as long
as we have a medical school there, or least
this seemed to be the idea. The meetings at
Ole Miss will be of mutual benefit to the doc-
tors and the students. The June meeting of the
combined societies will be held in Booneville.
A large attendance will be expected.
The scientific program at Ole Miss was
mighty good. Dr. J. L. Rubel of Columbus read
his first paper before the society, we believe,
and it was a good one, the subject being,
Roseola Infantum.
The Southeastern iSurgical Congress in Mem-
phis in March was a fine meeting. The papers
were good, the fellowship fine, the interest ex-
cellent, the attendance limited only by the
hotel accomodations.
We are very grateful for renewals of sub-
scriptions to the Mississippi Doctor by doctors
from the Mid-South. There are no finer doc-
tors in the world than those of the Mid-South.
It is good to have them as loyal friends.
Plans are now under way to have the an-
nual session of the Mid-South Postgraduate
Medical Assembly next February we under-
stand. We are not sure of the exact date,
but we think it opens about the thirteenth.
The Mid-South has served a fine purpose in
the past and it should render a still greater
service in the future. Its purpose is to give
the busy doctor a brief review of surgery
and medicine in a four-day course.
News and Comment
BLOOD PLASMA AVAILABLE FOR
CIVILIANS
Termination of both the European and Pa-
cific wars earlier than was anticipated has
made it possible for the American Red Cross
to redirect to civilian use much of the dried
blood plasma stock collected and processed
for Army and Navy use. The Red Cross
has on hand an estimated two years’ supply
of this valuable product which it will release
for use in civilian medicine.
A plan has been worked out for channel-
ing the blood plasma surplus to civilian use.
It has the approval of the American Medical
Association, the American Hospital Associ-
ation, and the Association of State and Ter-
ritorial Health Officers.
The plan provides for distribution through
state boards of health and county health de-
partments to hospitals and private physicians.
Hospitals and physicians in counties with full-
time county health departments will secure
their plasma needs from the local health de-
partment. In counties where there is no full-
time health service, requests may be made
directly with the Division of Preventable Dis-
ease Control, Mississippi State Board of
Health, Jackson, Mississippi. County health
departments will keep their supply replen-
ished from the reserve stock placed in the
State Board of Health.
It is suggested that physicians keep one
package on hand at all times and replace it
with another package as soon as used. Hos-
pitals also should endeavor to maintain an
adequate supply, remembering that stocks
can be replenished as needed.
The plasma is to be made available to all
patients needing it regardless of ability to
pay, but no charge can be made for the plas-
ma itself.
Each package contains two cans, one of
which contains sterile, distilled water and the
other the plasma. Instructions for combin-
ing the components are on the cans.
Blood plasma is useful in many conditions.
Possibly the best known are :
Shock
1. Traumatic, with hemorrhage or with-
out hemorrhage. Excessive bleeding at child-
birth, etc.
2. Operative.
592
News and Comment
March, 1946
Hypotroteinemia
1. Prolonged anorexia and prolonged star-
vation.
2. Conditions causing loss of serum such
as burns, oozing wounds, serious cavities be-
coming filled with serum such as peritoneal
irritation.
Excessive diarrheas.
There are other indications for the use of
plasma but on the whole it is helpful in most
conditions in which transfusion of whole
blood is needed and where whole blood is not
available at all or there is a delay in secur-
ing it. Physicians who desire more knowl-
edge on the use of plasma may obtain con-
siderable help from the books and journals
on file in the State Board of Health Medical
Library, where reference and loan service is
available for the asking.
In order to give the American Red Cross
an idea of the extent of the use of this plasma
and the conditions for which it is used, it is
required that each physician and hospital fill
out a brief report which comes with each
package and turn it in to the local health
department (or the iState Board of Health
where is no full-time local health department).
The report on each package used will en-
able the physician or hospital to obtain re-
placement packages as needed.
The Mississippi iState Board of Health and
the local health departments are glad to help
the Red Cross in making this valuable prod-
uct available and hopes that much benefit
and saving of life will accrue to patients
through its use.
ROSEOLA INFANTUM
(Continued from page 589)
the rash. It is rubelliform in type. It ap-
pears suddenly and usually simultaneously
over the trunk, extremities, neck and face. It
sometimes appears bnly on the trunk and of-
ten is more intense there. Less commonly,
the face, soles and scalp are involved. The
typical lesions are small rose-red macules, two
to three millimeters in diameter, circular, not
raised or only slightly elevated which fade on
pressure. The rash is identical with the rash
of rubella (German measles). They may be
quite sparse, only ten to twenty spots being
present, or so numerous and coalescent that
huge erythematous blotches may appear on
the back, abdomen or neck. The region about
the cheeks and nose is usually free from the
eruption. The rash lasts twenty-four to
forty-eight hours and then disappears, the
leucopenia rapidly returning to normal. Com-
plications are quite rare. Encephalitis with
recovery has been reported. Complications of
a co-existing coryza may occur.
Some complications are man-made and
avoidable. They include myringotomies unnec-
sarily, without release of pus or abating fever
and the use of sulfonamides with resultant
oliguria, albumin renal blockage and hema-
tological changes well known to all.
Prognosis is excellent. There is no known
specific therapy. Both sulfonamides and
anti-biotics exert no influence on membrane.
Treatment consists of purely symptomatic
measures. Needless isolation and quarantine
may be avoided if the disease is kept in mind
and recognized.
The disease must be differentiated from
measles, rubella, scarlet fever, influenza,
smallpox, typhoid fever, dengue fever and sul-
fonamide rashes.
Measles presents much more the symptoms
of coryza Koplik spots and a more intense
rash with continued fever after the rash ap-
pears. A much less lymphocytosis is usually
present in measles.
German measles does not usually have an
extremely high fever as roseola infantum may
have, and the rash of roseola infantum as be-
fore mentioned does not involve the cheeks
and nose, which is almost always in rubella.
In scarlet fever, the rash is much smaller
and punctate Pastia’s lines may be present,
the tonsils are usually fiery red and hemolytic
streptococci may be found on culture. A leu-
cocytosis with a shift to the left is invariably
found.
In epidemics of smallpox the prodromal
signs may be similar to infantile roseola but
palpation of the lesion and the leucocytosis
should help in differentiating.
The rash of infantile roseola may be indis-
tinguishable from a sulfonamide rash. Here
the history should be informative.
The fever of dengue fever usually lasts
longer and the patient is far more uncom-
fortable than in roseola infantum.
Roseola infantum is interesting chiefly
from a diagnosis standpoint, since no cure is
known and as the disease is self-limiting.
March, 1946
News and Comment
593
BIBLIOGRAPHY
Zahorsky, J. — Roseola Infantum, Breenneman's Prac-
tice of Pediatrics 2:21:1.
Dickey, L. B-— Rose Rash of Infancy — Stanford
Medical Bulletin, 3:37, 1945.
Clemens, H. H. — Exanthem Subitum (Roseola In-
fantum) Journal of Pediatrics, 26:66, January,
1945.
Barenburg; L. H., and reenspan, L- — Exanthem Subi-
tum (Roseola Infantum), American Journal Dis-
eases of Children, 58:983, November, 1939.
Moore, O. M. — Roseola Infantu, Journal Lancet,
656:: 243, July, 1945-
Rudolph, C. C. — Exanthem Subitum (Roseola Infan-
tum), Journal of Florida Medical Association,
25:547, May, 1941.
Jones, B- B. — Exanthem Subitum, Virginia Medical
Monthly, 66:401, July, 1939.
Stafford, G. E. — Exanthem Subitum, Archives of
Pediatrics, 56:246, April, 1939-
NEW GOVERNOR
Dr. Robert E. Schwartz, Hattiesburg, was
elected Governor of the American College of
Chest Physicians for the state of Mississippi
to succeed Dr. John S. Harter, formerly of
the State Sanatorium, who has removed to
Louisville, Kentucky. Dr. Harter is now chief
thoracic surgeon at the Hazelwood Sanato-
rium, Louisville, Kentucky.
RETURNED FROM MILITARY SERVICE
Dr. R. W. Hall, Jr., Jackson
Dr. J. E. Wadlington, Florence
Dr. R. M. Flynt, Meridian
Dr. R. J. Moorhead, Yazoo City
Dr. J. C. Green, Tupelo
Dr. D. T. Wilson, Louisville
Dr. N. O. Tyrone, Prentiss
Dr. K. D. Terrell, Prentiss
Dr. W. K. Stowers, Natchez.
Dr. Frank A. Wood, Jackson
Dr. H. F. Garrison, Jr., Jackson
Dr. J. A. Chustz, Jackson
Dr. S. G. Mounger, Greenwood
Dr. W. E. Sheffield, Charleston
Dr. C. T. Berry, Greenwood
Dr. M. E. Johnson, Meridian.
Dr. J. C. McGuire, Hazlehurst
Dr. B. F. Floyd, Jr., Bay (St. Louis
Dr. L. P. Crull, Jackson
Dr. Fred Geisenberger, Natchez
Dr. R. H. Pegram, Tupelo
Dr. T. G. Ross, Jackson
Dr. W. M. Kirk, Sardis
Dr. John H. Dent, Collins
Dr. F. B. Hays, Grenada
MISSISSIPPI PHYSICIANS WHO
DIED DURING 1945
John Thomas Barry, Caswell, 78.
Charles H. Wheeler (ocl.), Okolona, 66.
Harey John Flowers, Kilmichael, 73.
T. W. Kemmerer, Jackson, 68.
Marvin A. Cowden, Shannon, 66.
H, R. Miller, Winterville, 74.
R. A. Switzer, McHenry, 69.
W. H. Cooper, Catchings, 68.
Charles M. Davis, Laurel, 76.
Claude E. Boyd, Amory, 64.
S. E. Dunlap, Wiggins, 66.
Walter Frank Coleman, Hickory Flat, 60.
Samuel H. Howard, Durant, 82.
Charles Walter Patterson, Crowder, 71.
John W. Primrose, Clarksdale, 64.
James E. Anderson, Fearns Springs, 60.
M. E. Arrington, Vaiden, 40.
W. B. Maxwell, Nesbitt, 93.
A. W. Dumas (col.), Natchez, 69.
Y. E. Gordon, Bucatunna, 85.
B. E. Vowell, Carthage, 52.
H. S. Goodman, Cary, 71.
W. A. Williamson, Duffee, 75.
C. M. Speck, New Albany, 58.
W. A. Toomer, Tupelo, 61.
John E. Davis, Columbus, 78.
Andrew Patterson McArthur, Moss Point, 73.
Charles F. Hester, Newton, 65.
Lewis C. Jones, Madison, 84.
ANNOUNCEMENT
Harvey F. Garrison, Jr., M.D., F. A. A. P.,
announces his release from the Army and
resumption of the practice of pediatrics with
The Children’s Clinic, 409 Lamar Life Build-
ing, 315 E. Capitol Street, Jackson 2, Missis-
sippi. He is a diplomate of the American Board
of Pediatrics.
CLINICAL CONGRESS OF AMERICAN
COLLEGE OF SURGEONS
The American College of Surgeons an-
nounces that arrangements have been com-
pleted for the holding of its thirty-second
Clinical Congress at the Waldorf-Astoria,
New York, September 9 to 13, inclusive.
This will be the first Clinical Congress since
the meeting in Boston in 1941. Since that
time, 2,744 surgeons have been received into
fellowship in absentia, and to them in partic-
594:
News and Comment
March, 1946
ular the convocation on the opening night of
Congress will be a long anticipated event.
Dr. W. Edward Gallic of Toronto has been
president since November, 1941. Dr. Gallic
will give the Presidential Address on the eve-
ning of iSeptember 9 in the grand ballroom of
Waldorf-Astoria.
AMERICAN COLLEGE OF CHEST
PHYSICIANS
The next oral and written examinations for
fellowship in the American College of Chest
Physicians will be held at iSan Francisco on
June 29, 1946. Applicants for fellowship in
the College who plan on taking the examina-
tion should communicate with the Executive
Secretary, American College of Chest Physi-
cians, 500 North Dearborn iSt., Chicago 10,
Illinois.
The Twelfth Annual Meeting of the College
is scheduled to be held at the Sir Francis
Drake Hotel, San Francisco, June 29-30,
July 1-2.
CATALOG
A new catalog of technical books has just
been issued by the Chemical Publishing Co.,
Inc., 26 Court Street, Brooklyn 2, N. Y. This
catalog includes the latest books on chemistry,
physics, science, technology, medicine, foods,
formularies, drugs and cosmetics, engineering,
metals, technical dictionaries, building con-
struction, etc.
A copy of this catalog will be sent free to
everyone who is interested in keeping up with
the latest technical and scientific progress.
WANTED— LOCATION TO PRACTICE
Doctor, twenty-six years of age, native Mis-
sissippian, married, graduate of the Univer-
sity of Tennessee College of Medicine with
one year of rotating internship at a charity
hospital and two years of service in the Navy
Medical Corps. Desires associated practice with
older doctor in Mississippi with clinical and
hospital facilities available.
References furnished.
Write: Lt. Fred C. Wallace, MC, USNR,
U. S. Navy Personnel Separation Center,
NATTC, Bldg 58; Memphis, Tennessee.
ERROR
We are very sorry that through an error
in our office statements for the journal were
sent to many paid up subscribers in Missis-
sippi. We had new office help who failed to
understand this.
“ AMERICAN PUBLIC HEALTH
ASSOCIATION
The Executive Board of the American Pub-
lic Health Association announces the seventy-
fourth annual meeting of the Association to
be held in Cleveland, Ohio, the week of Novem-
ber 11, 1946.
THE SCHOOL-CHILD’S BREAKFAST
Many a child is scolded for dullness when
he should be treated for undernourishment.
In hundreds of homes a “continental” break-
fast of a roll and coffee is the rule. If, day
after day, a child breaks the night’s fast of
twelve hours on this scant fare, small wonder
that he i,s listless, nervous, or stupid at
school. A happy solution to the problem is
Pablum. Pablum furnishes protective factors
especially needed by the school-child — especial-
ly calcium, iron and the vitamin B complex.
The ease with which Pablum (or Pabena)
can be prepared enlists the mother’s coopera-
tion in serving a nutritious breakfast. This
palatable cereal requires no further cooking
and can be prepared simply by adding milk
or water of the desired temperature.
Tuberculosis is intimately linked with nu-
trition, both because the disease is common
under famine conditions, and because an in-
dividual’s lowered resistance is connected with
appetite disorders, and wrong dietetic habits.
One-third of tuberculous people cannot ob-
tain a proper diet on account of inadequate
income. Better nutrition for all will enable
the community to shoulder the burden of its
tuberculosis, and gradually diminish the weight
of that load. — NAPT Bulletin, England, June
1945.
Industrial x-ray programs are likely to play
a major role in tuberculosis control during
the next decade. — EJditorial, Am. Jpur. P. H.,
Nov., 1945. «a\ . . .
Interpreting
Staff of Review
Dermatology — James, G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
PEDIATRICS
Causes of Prematurity — Influence of Ma-
ternal Illness on the Incidence of Pre-
maturity; Employment of a New Criterion
of Prerematurity for the Negro Race and
Influence of Syphilis on the Incidence of
of Prematurity for the Negro Race and
A. Lyon, M.D. and Nina A. Anderson, M.D. —
November-December, 1945, American Journal
of Diseases of Children.
The authors observe that wnen birth weight
is used as the standard by which the maturity
of an infant is determined, it should be re-
membered that there are racial differences in
average birth weight. If the same standard is
used for the two races, an apparent difference
is observed in the incidence -of premature
births in the white and the Negro races. This
difference is statistically significant and is
true of the births to normal mothers and also
to those mothers whose pregnancy has been
complicated by some illness or abnormality.
It appears that more premature infants are
born to Negro women than to white women.
If, however, an arbitrary correction is made
to allow for the fact that Negro infants on the
average weigh less at birth than do white in-
fants, this apparent difference disappears and
the incidence of premature birth in the two
races is seen to be very similar.
In this summary and conclusipns the au-
thors say:
“L The incidence of prematurity among the
offspring of white women who were entirely
free from serious infections or other abnormali-
595
ties during pregnancy was 5.5 per cent. The
rate rose to 13.5 per cent among the infants
whose mothers had some illness during preg-
nancy.
“2. The incidence of prematurity among the
offspring of Negro women was higher, the re-
spective percentages being 9.2 and 116.6. When
the criterion of prematurity for Negro infants
was adjusted to make their stage of maturity
more comparable to that of white infants,
these racial differences of incidence dis-
appeared. From our data the lowering of the
upper limit of birth weight from prematurity
of the Negro infants from 5 pounds 8 ounces
(2,500 Gm.) to 5 pounds 3 ounces (2,350 Gm.)
seemed to justify.
“With such a classification, the percentage
of premature delivery was 5.7 for Negro wo-
men with normal pregnancies, as compared
with 5.5 for the women of the white race.
Among the Negro mothers whose pregnancies
were complicated by some illness, the per-
centage of premature delivery was 12.5 as
compared with 13.5 among the white mothers.
“3. Approximately 80 per cent of the still-
born infants of both races were the offspring
of mothers who had had some illness during
pregnancy. The majority of stillborn infants
were prematurely born (whether or not the
mother was in good health during pregnancy.)
“4. Maternal illness appears to be associated,
either directly or indirectly, with about 65 per
cent of single live-born premature infants and
with 80 per cent of stillborn infants.
“5. The relative importance of various ill-
nesses and abnormalities as single predisposing
etiologic factors will be the subject of further
investigation.”
The authors on the same subject which
deals with the influence of syphilis on the in-
cidence of prematurity have this to say:
“I Prematurity was somewhat more fre-
quently characteristic of the offspring of sy-
philitic women than of the infants of non-
syphilitic women. For the white race the re-
spective percentages were 14 and 9. For the
Negro race they were 17 and 12 per cent but
when the standard of prematurity was adjusted
to include as premature only the Negro in-
fants weighing less than 5 pounds 3 ounces
(2,300 Gm.) the rates of prematurity were
approximately the same a&lfor the white race;
namely, 13 and 9 per cent.
596 Interpreting Medical Literature e March, 1946
“2. The influence of maternal syphilis on
the prematurity rate was evaluated more pre-
cisely by comparing the group of women who
had no detectable illness during pregnancy
with the group of mothers whose only ab-
normality was syphilis. Prematurity was noted
for five per cent of the white mothers who has
normal pregnancies and for ten per cent of
those with syphilis only. Among the Negroes,
the respective rates were 9 and 13 per cent,
but with the adjusted standard of prematurity,
the rates among Negroes became 6 and 10 per
cent, which is almost identical with the rates
observed among the white patients.
“3. When the live-bom infants were con-
sidered as a separate division (omitting the
stillborn), the prematurity rate in the white
race was slightly but not significantly elevated
by the occurrence of maternal syphilis. In the
Negro race the difference observed was of
statistical significance. Prematurity rates
among stillborn infants were not significantly
altered by the presence of maternal syphilis.
Differences of the same magnitude were noted
when the group of mothers who had normal
pregnancies was compared with the group of
those who had syphilis only.
“4. There was a higher incidence of syphilis
in the Negro women than in the white. Such
a finding has frequently been interpreted to
mean that syphilis causes a higher rate of pre-
mature delivery for Negro women. Our ob-
servations indicate that the incidence of pre-
maturity among syphilitic women was ap-
proximately the same for the two races.
“5. Specific therapy administered to syphili-
tic patients during pregnancy had pronounced
effects in reducing the rate of prematurity.
Among white mothers whose only illness dur-
ing pregnancy was syphilis, therapy was as-
sociated with a drop in prematurity rates from
16 to 1-0 per cent. Among Negro mothers the
rates fell from 23 to 6 per cent.
“6. When diseases or abnormal conditions
other than uterine bleeding were associated
with syphilis during pregnancy, the prema-
turity rates were slightly but not significantly
elevated above those of groups in which syph-
ilis occurred alone. The association of syphilis
and conditions producing uterine bleeding re-
V:7 \ ■' T/f-TH; ! i r ; • " ..**
suited in a pronounced increase in the iiici-
4- rC«j 'Jjx
dence of premature deljvery,” q j,os £x
\ • b, " • '■ ^
COMMENTS
On account of the extensive investigation
and study on the causes of prematurity in a
great number of cases studied by these au-
thors, I thought it would be interesting to the
medical profession of our state for them to
have the opportunity to review the two papers
by the same authors in the November-Decem-
ber issue of the American Journal of Diseases
of Children which is just off the press.
Since Mississippi has such a very large Ne-
gro population the findings in this case are
quite interesting. It is very timely since it is
well known by the members of the medical
profession of our state that prematurity is the
leading cause of infant mortality which I regret
to admit is too great in our state.
DERMATOLOGY
Volume 52 — Number 5
November-December, 1945
Pages No. 405 and 406
Child::' Demonstration of Virus and Com-
ment on “Kaposi's Varicelliform Eruption.”
Falls B. Hershey and! William E. Smith, Am.
:hild. 69.33 (Jan.) 1945.
In this communication from the department
of pediatrics and of pathology of the Massa-
chusetts General Hospital, a case is reported
of generalized vaccinia occurring in an ecze-
matous child after exposure to a recently vac-
cinated brother. The vaccine virus was re-
covered from the cutaneous lesions, and anti-
bodies against this virus were demonstrated in
the serum of the patient. The cutaneous
lesions of the vaccinia developed almost ex-
clusively in the eczematous areas.
Recently, agents closely resembling herpes
simplex virus have been recovered from simi-
lar eruptions known as Kaposi’s varicelliform
eruption or pustulosis arioliformis acuta.
Since these eruptions occur in patients with
eczema, they were formerly considered to be
identical with eczema vaccinatum. However,
a considerable number of patients have failed
to yield either vaccinia or herpes virus de-
spite appropriate tests. The suggestion is
made that this May be due to other viruses
locatMfig in the eczematous areasi^s® cae-
March,; ,}946 State. a^oard.
The Chemotherapy of Syphilis. Joseph E.
Moore, Am. J. Syph., Gonor. & Ven. Dis.
29:185 (March), l£4&:iaH9iab aidolyoit
of Health ^ 597
- STAT-C 7 ~
vided an extensive, thorough and critical re-
view of literature pertinent to syphilis. The
present review covers the period from July,
This is an excellent article which Reviews
the chemo-therapy~ of syphilis from the first
appearance of the disease in Europe, in 1943,
until October, 1945. / The last half of the ar-
ticle is devoted to the use of penicillin in treat-
ment of syphilis, but since the picture re-
garding penicillin is changing so rapidly, de-
tails regarding its use are omitted from this
abstract, except the statement that penicillin
is new and powerful addition to syphilo-
therapy.
Syphilis: Review of the Recent Literature. E.
Gurney Clark, Joseph Earle Moore, Charles
F. Mohr, Virgill iScott and Richard D. Hahn,
Arch. Int Med. 74:390 (Nov.), 1944.
Mohr and his associates have again pro-
1943, to July, 1944, and is divided into sec-
tions relating to various laboratory, public
healthy "therapeutic and clinical phases of the
disease.
>■' • aft ' P *
There is need for greater recognition of the
problem of the recovery of the aged. Many
are of the chronic type, able to be about, and
therefore more dangerous because of the po-
tentialities of spreading infection to others,
particularly young children. Tuberculosis
mortality rates are falling, but in general the
percentage reduction is much higher in the
younger groups than among those of older
age. Murray A. Auerbach, Bulletin, Indiana
State Bd. of Health, Nov., 1945.
State Board of Health
Felix J* Underwood, M .D.
MEETING THE EXTRA HEMOGLOBIN
NEEDS OF EXPECTANT MOTHERS
VIRGINIA HOWARD, M.D., M.P.H., Director
Division of Maternal and Child Health
It is estimated that approximately 43 per
cent of women in the childbearing age in the
South have hemoglobin values lower than 80
per cent. Hence the physician is concerned with
the problem of meeting the extra hemoglobin
needs of expectant mothers in more than one-
third of his maternity cases. These lowered
values among women are due in great part to
the low protein and iron intakes of their diets
prior to pregnancy.
A recent nutrition study in Tennessee re-
vealed that 599 per cent white adults had
low intakes of iron and that 51 per cent had
low intakes of protein. When a physician
considers the fact that during pregnancy
there is a 30 per cent increase in the need for
protein and a 25 per cent increase in the need
for iron, the importance of meeting these
needs of the expectant mothers under his
care becomes apparent.
Iron has always been considered a keynote
for hemoglobin construction, but frequently
one fails to realize that with a diet adequate
in iron and low in protein, hemoglobin regener-
ation is still minimal. The hemoglobin mole-
cule is composed of 96 per cent protein and
only 4 per cent is an iron-containing pig-
ment called heme. The normal adult woman
needs an intake of 60 grams of protein and
12 grams of iron. Translated into an aver-
age diet this means:
Intake of 660 Grams Protein
1 pint of milk 16.6 gms.
1 egg 6.2 gms.
3J oz. meat 24. gms.
(The remaining 13 grams will be derived
from other articles in the diet.)
Similarly, an intake of 12 mgm. of iron
means :
1 egg 1.4 mgm.
3J oz. meat 4.5 mgm.
1 serving greens 3.2 mgm.
4 slices of bread -2.0 mgm.
598
State Board of Health
March, 1946
(The remaining .9 of a mgm. will be de-
rived from other foods.)
An expectant mother’s requirement for
other foods.)
An expectant mother’s requirement for
iron is 15 mgm. and for protein is 85 grams.
In order to add approximately 25 grams of
protein and 3 mgm. of iron to the diet it is
necessary that the expectant mother utilize
daily the equivalent of the following foods:
1 extra pint of milk 16.6 grams
1 serving of dry beans 6.4 grams
(for protein)
1 extra serving of greens 3.2 mgm.
(for iron)
It should be remembered that an excellent
diet during pregnancy can not compensate
for lowered hemoglobin values present when
the woman became pregnant. In a food in-
take of 15 mgm. of iron a day the expectant
mother absorbs only 1 mgm. A good diet
will raise the hemoglobin of an expectant
mother approximately only 1 per cent a
month.
With an adequate iron therapy, of which
ferrous sulphate in 5-grain doses four times
a day still seems to be the best and cheapest,
the hemoglobin, provided the daily protein
needs are met, will increase approximately 1
per cent a day.
In studying the dietary intakes among ex-
pectant mothers in Mississippi, it is not un-
common to encounter diets containing only
30 to 40 grams of protein a day and 4 to 6
mgm. of iron daily. One of the most fre-
quent reasons for- a low protein intake is the
unwillingness of the expectant mothers to
consume the quart of milk daily which their
physicians routinely advise. Milk has al-
ways been stressed as a source of calcium.
In addition it should be pointed ou that it
offers in protein content the equivalent of
one and one-half servings of meat. The sub-
stitution of calcium tablets leaves this pro-
tein requirement unmet, and similarly fails
to supply the 80 per cent riboflavin intake
met by the expectant mother’s daily consump-
tion of a quart of milk.
In 1944 in Mississippi there were 45 ma-
ternal deaths due to hemorrhage. Many
mothers were incapacitated for long periods
of time as a result of lowered hemoglobin
values. This might have been prevented
through careful hemoglobin determinations
during pregnancy and during the postpartum
period. A simple and accurate method for
hemoglobin determination is that of Phillips.
Physicians interested in the Phillips’ technic
and in a suitable pamphlet of instructions for
expectant mothers relating to dietary prob-
lems may write to the Division of Maternal
and Child Health, Mississippi State Board of
Health, Jackson 113, Mississippi, for a free
copy of each.
• Maternal and infant mortality rates have
been steadily declined in the past quarter of
a century as a result of improved public
health, medical and hospital facilities. How-
ever, there still remains a large gap in knowl-
edge known and knowledge applied. Physi-
cians and public health workers can be
counted upon to do everything they can to
bridge this gap and thus save lives and build
stronger, healthier Mississippians.
CANCER MEETING
On February 26 at Vicksburg there was
held the first District meeting of the Mis-
sissippi Division of the American Cancer So-
ciety. Mrs. Elizabeth N. Wates, State Com-
mander, reports that there was an excellent
program and that the response from those
in attendance was very enthusiastic. Among
the speakers were Dr. Alton Ochsner of New
Orleans, and Mrs. H. B. Ritchie, Regional
Commander of the American Cancer Society,
Atlanta.
Mississippi’s county chairmen are making
good progress in organizing the fight to con-
trol cancer and from their efforts the people
of the State are developing a new sense of
awareness that cancer can be prevented and
that it can often be cured if a person will
seek proper medical care in its early stages.
The Society’s slogan, “Fight Cancer With
Knowledge,” is beginning to make itself felt
as workers strive in new earnest to present
accurate facts regarding this disease to every
section.
ADVANCES IN TREATING VENEREAL
DISEASES
Improved methods of treating gonorrhea
and syphilis will be the subject of a half-day
refresher course for physicians of the State
to be held at various points February 25 to
March 20. Dr. Percy Pelouze of the Depart-
ment of Urology, University of Pennsylvania
April, 1946
Woman’s Auxiliary
599
Medical School, well-known authority on the
venereal diseases, will conduct the courses.
Others taking part include Dr. H. Worley
Kendell of the Mississippi State Fever The-
rapy Unit, Dr. Terrence Billings, Medical Di-
rector of the Delta Medical Center, and Dr.
Wm. G. Hollister, Supervisor of Venereal Dis-
ease Control, Mississippi State Board of
Health.
The courses have been organized for the
convenience of the private physician to pro-
vide him with a fairly complete picture of
recent developments in the effective treat-
ment of gonorrhea and syphilis and at the
same time to give him an opportunity to pre-
sent problem cases or any questions regard-
ing problems he might have. There will be
no registration fee for the courses and it is
designed to hold them at points which will
permit the largest possible number of physi-
cians to attend with a minimum loss of time
from busy offices.
For further information or details, write
to Dr. A. L. Gray, Director, Division of Pre-
ventable Disease Control, Mississippi State
Board of Health, at Jackson, or make inquiry
at your local health department.
PREVALENCE OF COMMUNICABLE
DISEASES IN MISSISSIPPI
January January 5 -Year
1946
1945
Average
Acute Poliomyelitis
7
2
2.6
Bacillary Dysentery
425
633
437.8
Dengue
0
0
0.0
Diphtheria
. 38
37
31.6
Influenza
.20034
8728
14225.2
Measles
. 1176
485
1313.0
Meningococcus
Meningitis
20
20
27.2
Other Forms
Meningitis
2
3
5.0
Pellagra
. 138
156
170.2
Pneumonia
. 2568
2247
2597.6
Pulmonary
Tuberculosis
. 150
132
122.6
Scarlet Fever ....
70
174
81.4
Smallpox
1
0
1.4
Tularemia
5
1
3.6
Typhoid Fever
5
5
3.6
Typhus Fever
4
12
5.4
Undulant Fever ....
1
8
2.2
Whooping Cough ...
. 360
546
632.6
Womans Muxiliary
President Mrs- L. J. Clark
Vicksburg
President-Elect Mrs. Stanley Hill
Corinth
First Vice-President Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
CENTRAL MEDICAL AUXILIARY
Mrs. W. F. Hand was elected president of
tne Woman’s Auxiliary to the Central Medical
Society at the March meeting in the home of
Mrs. J. P. Wall, 747 Belhaven Street. Serving
with Mrs. Hand will be Mrs. H. R. Shands,
vice-president; Mrs. J. Gordon Dees, secretary;
Mrs. W. C. Thompson, treasurer; Mrs. H. C.
Ricks, parliamentarian; Mrs. T. W. Kemmerer,
historian.
Mrs. G. E. Riley presided over the meeting
which was opened with the reading of the
collect for clubwomen by Mrs. George W. Ow-
en.
Mrs. J. I. Wates, state commander of the
Field Army of the American Cancer Society,
was the guest speaker, being presented by
Mrs. W. H. Waddle, Hinds County chairman.
Mrs. Wates, in a short and informative talk,
explained the purposes and aims of the so-
ciety and urged the cooperation of the auxi-
liary.
Mrs. L. W. Long was appointed general
chairman, and Mrs. H. C. Sheffield, co-chair-
man, for the state convention, to be held in
May.
Doctors’ Day Party will be held in April.
A rising vote of thanks was given the of-
ficers for their work during the past year.
Following the business session, members and
guests were invited into the dining room, where
the beautifully-appointed table held an ar-
rangement of spring flowers, harmonizing with
those in the living room.
600
Woman’s Auxiliary
March, 1946
Mrs. Riley and Mrs. Hand poured" f^ar SHhi
the silver services. Dainty sandwiches, cakes
and nuts tofer-e -served hy ,,4he. following hos-
tesses: Mrs. W.'*R. Beathea, Mrs. Harvey Gar-
rison, Mrs. P. R. Greaves.
n Mrs. J. E. McDill, Mrs. W. F. Hand, : Mrs.
I'M. G. Sheffield, Mrs. T. E. Wilson, Mrs. Tem-
ple Ainsworth and Mrs J. P. Wall.
Those present included : Mrs. G. E. Riley,
Mrs. A. Ik Gray, Mrs. J. Gordon Dees, Mrs.
I. J. Waits, Mrs; W. H. Waddell, Mrs T. G.
' Ross, Mrs. T. Moore, Mrs. F. J. Underwood,
Mrs. C. F. MacKenzi, Mrs. C. B. Mitchell,
Mrs. N. B. Walker, Mrs. Robin Harris, Mrs.
T. J. Blake, Mrs. L. W. Long, Mrs. Brister
Ware, Mrs. Lauch Hughes, Mrs. L. T. Carl,
Mrs. Van Dyke Hagaman, Mrs. I. C. Hug-
gins, Mrs. Lee M. Lipscomb, Mrs. W. M.
Dabney, Mrs. W. C. Thompson, Mrs. Boyd Ed-
wards, Mrs. H. F. Magee, Mrs. W. H. Sim-
mons, Mrs. J. A. Schustz, Mrs. J. A. Milne,
Mrs. F. D. Hollowell, Mrs. R. C. O’Ferral, Mrs.
T. E. Wilson, Mrs. J. E. McDill, Mrs E. H.
Galloway, Mrs. O. A. iSchmid, Mrs. W. F.
Hand, Mrs George Owen, Mrs. J. C. Rude, Mrs.
H« R. Shands, Mrs. Marion W. Murphy, Mrs.
A. G. Wilde, Mrs. Temple Ainsworth, Mrs. P.
R. Greaves, Mrs. H. C. Sheffield, Mrs. H. C.
Ricks, Mrs. Harvey Garrison, Mrs. W. R.
Bethea, and Mrs J. P. Wall.
TRI-COUNTY MEDICAL AUXILIARY
The first meeting of the Tri-County Medi-
cal Auxiliary for 1946 was held in the home
of Mrs. R. C. Massengill, Brookhaven, on
March 12, with the wives of the Brookhaven
physicians as co-hostesses for luncheon. The
unusual procedure of meeting in a lovely home,
made even more lovely by beautiful arrange-
ments of spring flowers, proved a most effec-
tive way for an organization to begin a new
year. A double feature of the occasion was
the presentation of the incoming president,
Mrs. B. L. Crawford of Tylertown, and the
guest speaker, our state president, Mrs. L.
J. Clark, of Vicksburg. Each was presented
a beautiful corsage.
The meeting was called to order by the
retiring president, Mrs. W. H. Frizell of
Brookhaven, who in turn introduced the new
president, Mrs. B. L. Crawford. After greet-
“ big the members and guests, Mrs. Crawford
asked Mrs. O. N. Arrington of Brookhaven,
to1 return thanks before the delicious luncheon
was served.
r Yitzc ft:; i : u soi . • .
Following the luncheon, the minutes, of the
December meeting were read by the secretary-
treasurer, Mrs. C. E. Mullins of Brookhaven
before Mrs. Clark was introduced. After pre-
senting the, purpose and aims of ^be State Medi-
cal Auxiliary and familiarizing the members
witjh publications related to the Auxiliary, Mrs.
Clark highlighted her talk with a thought-
provoking discussion of the Wagner-Mufray-
Dingell bill. In this discussion Mrs. Clark gave
a clear and concise explanation of the bill
and its threat to the medical profession. She
pled that each member of the Auxiliary
avail herself of every opportunity to inform
others of the true meaning of this bill and
what it will do to our country and to Ameri-
can medicine. She urged that we contact our
congressmen and senators immediately and
vigorously protest against this strictly un-
American political proposal.
Members and guests present included: Mrs.
Thomas Burk, Mrs. James Blane, Mrs. Thomas
F. McDonnell, Mrs. R. B. Zeller, Hazlehurst;
Mrs. B. L. Crawford, Mrs. A. B. Harvey,
Tylertown; Mrs. W. L. Little, Wesson; Mrs.
O. N. Arrington, Mrs. Jack Atkinson, Mrs. W.
H. Frizell, Mrs. H. R. Fairfax, Mrs. J. H. Lip-
sey, Mrs. J. R. Markette, Mrs. F. C. Massen-
gill, Mrs. R. C. Massengill, Mrs. C. E. Mullins,
Mrs. R. S. Savage, Brookhaven; and Mrs. J.
S. Tobis of Jackson.
AUXILIARIES CONSOLIDATE
The members of the Northeast Mississippi
Thirteen Counties Auxiliary and the North
Mississippi Society met as one group at the
University Center on the University pf Mis-
sissippi campus March 12, and made plans for
consolidation along with the doctors.
The ladies were welcomed by the doctors’
wives of Oxford, Mrs. B. S. Guyton and Mrs.
J. C. Gulley being assisted by others of the
town. Dr. W. A. Evans of Aberdeen was the
guest speaker for the afternoon, making a
delightful and provocative commentary on
life.
Tea was served by the hostesses, climax-
ing entertaining readings by the expression
instructor at Ole Miss.
The combined groups will meet in June in
Booneville.
OFFICERS 1945-46
PRESIDENT
B. Lampton Crawford Tylertown
PRESIDENT-ELECT
J. K. Avent Grenada
VICE-PRESIDENTS
E. K. Guinn Okolona
J. T. Weeks Jackson
L. W. Brock McComb
HISTORIAN
J. G. Thompson Jackson
EDITOR
Lawrence W. Long Jackson
ASSOCIATE EDITORS
Stanley A. Hill ( One Year) Corinth
L. Hughes ( Two Years ) Jackson
SPEAKER OF THE HOUSE
J. Rice Williams Houston
TREASURER
J. F. Lucas Greenwood
SECRETARY
T. M. Dye Clarksdale
COUNCIL
First District
J. W. Lucas Moorhead
Bolivar, Coahoma, Humphreys, LeFlore, Quit-
man, Sunflower, Tallahatchie, Tunica,
Washington
Second District
L. L. Minor Route 4, Memphis, Tenn.
Benton, DeSoto, Lafayette, Marshall, Panola,
Tate, Tippah, Union, Yalobusha
Third District
R. B. Caldwell Baldwyn
Alcorn, Calhoun, Chickasaw, Clay, Itawamba ,
Lee, Lowndes, Monroe, Noxubee, Oktibbeha
Pontotoc, Prentiss, Tishomingo
Fourth District
W. H. Curry Eupora
Attala, Carroll, Choctaw, Grenada, Holmes
Montgomery, Webster
Fifth District
H. C. Ricks Jackson
Claiborne, Hinds, Issaquena, Leake, Madison,
Rankin, Scott, Sharkey, Simpson, Smith,
Warren, Yazoo
Sixth District
Lamar Arrington Meridian
Clark, Kemper, Lauderdale, Newton, Neshoba,
Winston
Seventh District
R. F. Ratliff Lucedale
Covington, Forrest, George, Green, Jasper ,
Jefferson Davis, Jones, Lamar, Marion,
Pearl River, Perry, Wayne
Eighth District
W. H. Frizell Brookhaven
Adams, Amite, Copiah, Franklin, Jefferson,
Lawrence, Lincoln, Pike Walthall,
Wilkinson
Ninth District
D. J. Williams Gulfport
Hancock, Harrison, Jackson, Stone
COMMITTEES
PUBLIC POLICY AND LEGISLATION
A. Street, ( One Year) Vicksburg
Henry Boswell (Two Years) ........Sanatorium
W. H. Anderson ( Three Y ears) ...... Booneville
PUBLICATION
L. W. Long, Editor Jackson
Stanley A. Hill ( One Year) Corinth
L. Hughes ( Two Years) Jackson
PROGRAM
THE SECRETARY
CHAIRMEN OF SECTIONS
CONSTITUTION AND BY-LAWS
D. W. Jones ( One Year) Jackson
W. W. Crawford (Two Years) ......Hattiesburg
W.H. Frizell (Three Years) Jackson
BUDGET AND FINANCE
Gilruth D Arrington (One Y ear) ....Yazoo City
George Adkins (Two Years) Jackson
B. B. O’Mara (Three Years) Biloxi
EXHIBITS
D. W. Jones (One Year) Jackson
J. G. Thompson (Two Years) Jackson
George Riley (Three Years) Jackson
CHAIRMEN OF SECTIONS
MEDICINE
H. C. Sheffield Jackson
surgery
A. B. Harvey , - Tylertown
public health
T. Paul Haney Laurel
eye, ear, nose and throat
S. B. Caruthers Grenada
The Mississippi Doctor
March, 1946
EXPLODING STEAM, when bus driver removed radiator cap,
caused second-degree burn of face, right shoulder, anterior chest,
abdomen. Application of CHLOR-U-CAIN over period of two
weeks — complete healing without scarring.
ACIDS in chemistry set gave 1 2-year old boy second-degree burns
of palms and dorsums of both hands. Two applications of CHLOR-
U-CAIN encouraged complete healing without scarring.
VARICOSE ULCER of 58-year old man's right inner ankle persisted
for three months. Marked improvement after three applications of
CHLOR-U-CAIN, discharged after two weeks' treatment.
(Three of many on file.)
Warren-Teed Ethical Pharmaceuticals: capsules , elixirs ,
ointments , sterilized solutions, syrups, tablets . Write for
literature .
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BENZOCAINE 10% • OINTMENT BASE
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THE WARREN-TEED PRODUCTS COMPANY. COLUMBUS 8. OHIO
Uterine Bleeding-Organic and Functional;
Diagnosis and Treatment*
GILBERT F. DOUGLAS, M.D., F.A.C.S.,
F.I.C.S.
Birmingham, Alabama
This is such a ibroad subject that we could
spend days in discussing. For that reason,
we are going to hit just the high points.
In uterine bleeding there are three major
principles to keep in mind. I think if we can
catalogue them in our minds it will make
diagnosing a little easier.
Causes of Bleeding.
1. Functional. That type of bleeding which
is not identified with any particular disease
as far as we know.
2. Endocrine. Where there is a disturbance
of the endocrine glands, with which you are
familiar. That group has an internal secretion
without external drainage.
3. Organic. As in malignancies or from defi-
nite diseases.
Another classification that it is well for
us to keep in mind is the age classification.
We have very few diseases which cause bleed-
ing in childhood. They are embryonic tumors
or granulosa cell tumors. Possibly all of us
have seen one or two cases in which there
was uterine bleeding in a very young child,
three, four or seven years of age, which began
very much like menses. This bleeding is not
a true menstruation. Usually it is due to some
stimulus from a disease of the ovary, which
frequently is granulosa cell tumor.
The next age group is puberty. There are
more points to be considered in this age classi-
fication than the younger group. You are
familiar with the estrogenic type. This stimula-
tion comes in the first half of the cycle due
to estrogen formation. If there is no progestin
formed in the second half of the cycle, bleed-
ing will continue. In childhood this is often as-
sociated with absence of ovulation, where no
progestin or corpus luteum is formed.
Next is the adolescent, which of course is
the larger group. There are three classifica-
tions: 1) organic, 2) functional, 3) endocrine.
You would expect to find all of these condi-
tions in the adolescent group — tumors of the
♦Presented and discussed at postgraduate seminar
on obstetrics and grynecology, Medical College of
Alabama, Birmingham, Alabama, January 25, 1946.
**Dr. J. F. McDowell and Dr. T. B. Norton, Bir-
mingham, Alabama, entered in round-table discus-
sion with questions from the audience.
ovaries, pelvic inflammatory condition, con-
stitutional diseases, etc., and malignancies. Ma-
lignancies have been placed last for emphasis,
but in reality should be first.
MENOPAUSAL BLEEDING
1. Ovarian. This often comes along with
ovarian deficiencies in the declining years of
life.
2. In ovarian secretion with absence of ovu-
lation— there is no corpus luteum formed —
nothing to “put on the brakes.”
3. Fibroma. Incidentally fibroma is not near-
ly as frequent a cause of bleeding as we form-
erly thought, unless there is a fibroid near the
endometrium. There may be a number of them
in the uterus without causing bleeding.
4. Constitutional diseases. Tuberculosis, car-
diovascular diseases, nephritis, etc.
5. Ovarian tumors. Either large or small
may cause a stimulation of estrogen to the en-
dometrial lining.
6. Thyroid deficiency. Quite frequently this
is associated with bleeding.
7. Endocrine. Thyroid, pituitary, ovarian,
adrenal, etc.
8. Malignancies. This should be first. As
Dr. Jones told us yesterday, “we expect 50
per cent of bleeding beyond the menopausal
period to be from malignancy.”
POSTMENOPAUSAL BLEEDING
1. Ovarian tumors, granulosa cell tumors,
ovarian cysts, etc. In childhood the granulosa
cell tumors are the cause of uterine bleeding
in a few instances. In postmenopausal pa-
tients, granulosa cell tumors are occasionally
in this group also. If a patient goes through
the menopause at forty-five to forty-eight
years of age, stops for fifteen years, and then
begins to menstruate, frequently on checking
there is nothing, like an ovarian tumor, about
the cervix or uterus to account for the bleed-
ing, so you would naturally suspect a granu-
losa cell tumor.
2. Tuberculosis or cervicitis may cause
bleeding.
3. Carcinoma — placed last for emphasis, is
one of the most frequent causes.
Abnormal uterine bleeding is a common
603
604
Uterine Bleeding — Douglas
April, 1946
gynecological symptom, but it is only a symp-
tom. NO BLEEDING WITHIN ITSELF IS A
DISEASE. If you can think of it this way,
it will serve as an incentive to start looking
for the disease and you will not go astray.
Functional bleeding is not related to any
particular disease.
In organic bleeding definite disease is found.'
Endocrine bleeding denotes disease of the
ovaries, pituitary, thyroid, etc.
Amenorrhea — absence of bleeding, primary
or secondary.
Although we are discussing bleeders, as-
sociated with them we might think of the
group of girls or older people with absence
of bleeding. They can give you more concern
than almost anything you will have to deal
with in the first years of a girl’s adolescent
life. When a girl reaches puberty and has
menstruated once or twice, then stops for a
year or more, she becomes alarmed about it.
Some advocate going on until the patient is
eighteen or twenty years of age without do-
ing anything about it. Personally, I do not
think we should wait until the patient is twen-
ty years of age to establish or re-establish
menstruation, without making a correct diag-
nosis. If unable to establish menstruation be-
fore that age, it will probably not ever be
established normally. She will have long
periods of cessation and possibly sterility as-
sociated with it. By starting earlier it is easier
to do something about it.
Metrorrhagia — bleeding between times. This
is not necessarily associated with abnormal
menstruation.
Cyclic bleeding. This may be normal and
may be short or prolonged.
Absence of bleeding may be incidental to:
1) occurrence of true menstruation (associated
with ovulation), 2) delayed menstruation, 3)
pregnancy, 4) intercurrent disease, 5) inter-
current disturbance of function, 6) premature
menopause, 7) menopause.
1. Estrogenic bleeding may occur from: 1)
normal estrogenic endometrium. We will not
take much time in this discussion to talk of
the endometrium, but we do want to keep this
one fact in mind: Where there is an endo-
metrium or uterine bleeding that is not part
of the cycle, there is often a disturbance either
with the pituitary or with the thyroid gland.
Some claim that anovulation bleeding is not
true menstruation. 2) Hypoestrogenic endo-
metrium. An insufficient amount of estrogen
We think of theelin more than any other pro-
duct as the preparation to give to supply es-
trogen deficiency 3) Hyperestrogen. Over-
stimulation of the endometrium.
2. Progestin bleeding may occur from: 1)
A mass of cells not developed to the same de-
gree as the other endometrium cells. This may
be normal bleeding for that particular gland,
which is out of gear with the other part of
the endometrium. 2) Mass of cells in the en-
dometrium— corpus luteum forms in the last
half of the cycle. 3) Immature progestational
endometrium. 4) Normal progestational en-
dometrium. 5) Decidua-like progestational en-
dometrium. (These two classifications may be
combined in this manner). 6) Cyclic estrogenic
bleeding. This may be scanty in amount and
short in duration. 7) Cyclic progestation. This
may be prolonged in duration and excessive
in amount.
ETIOLOGICAL FACTORS ON NORMAL
UTERINE BLEEDING
The etiological factors may be classified as
follows :
1. Physiological alterations in uterine bleed-
ing, including sexual immaturity, pregnancy,
and the climacteric.
2. Gestational bleeding, including abortions,
hydatidiform mole, chorionepithelioma.
3. Bleeding due to infections, including puer-
peral and non-puerperal endometriosis and ad-
nexitis.
4. Bleeding due to neoplasm or tumors, in-
cluding uterine, cervical and ovarian tumors —
with the exception of endocrine tumors of the
ovaries, etc.
5. Bleeding due to cervical pathology.
ALTERATIONS IN UTERINE BLEEDING
1. Due to erosion, obesity, etc. For instance
a woman who has had normal menstruation
and all of a sudden begins to put on weight
and have disturbance with menstruation. There
may be either of two reactions — profuse bleed-
ing or amenorrhea.
2. Malnutrition.
3. Constitutional diseases.
4. Wasting diseases — cachexia.
5. Blood disturbances.
6. Psychological factors.
7. Change in climate. If a person moves
April, 1946
Uterine Bleeding — Douglas
605
from the North to the South, or vice versa,
she may have considerable disturbance with
menstruation for several months.
UTERINE BLEEDING DUE TO ENDOCRINE
DISEASES
1. Endocrine tumors causing ovarian dys-
function, etc.
2. Many polyps form in the endometrium
itself and incidentally the glands on these
polyps will function but at irregular intervals.
3. Adenocarcinoma.
4. Endometrial function may be altered by
ovarian disturbance related to salpingitis,
etc.
5. Uterine bleeding is often characterized
by a depleting hemorrhage and may cause
undesired sterility.
SYMPTOMS OF ABNORMAL UTERINE
BLEEDING
First, functional uterine bleeding during ado-
lescence, is most irregular and profuse.
Symptoms due to functional disturbance of
the ovaries or endometrium.
The ovary is the gland that takes first place
as the cause of bleeding. Bleeding actually
comes from the endometrium which may be
the end result where there is a disturbance
due to other abnormal functions.
Many patients bleed but do not have normal
menstruation, due to stimuli on the endometri-
um. They have not ovulated and do not have
corpus luteum present. The continued stimu-
lation may come in season or out of season,
whether bleeding is progestational or estro-
genic. When the patient is well developed or
even over-developed for her age, it is very
misleading to the doctor and the mother. If
there is bleeding, it is thought to be men-
struation. The reason for these prolonged
periods of bleeding should be ascertained.
Prolonged and excessive periods of estro-
genic bleeding may occur at frequent inter-
vals and yet the patient may be free from
bleeding for months at a time — perhaps three
to six months. Anemia or poor general health
may be noted. This makes the patient self-
conscious.
The physician has two obligations to the
adolescent who has irregular bleeding. First,
HEMOSTASIS and second, CORRECTING the
imbalance. An early diagnosis should be made.
An endometrial biopsy is indicated. It is a very
easy procedure to get the required amount of
material and the set-up is quite simple.
We had a clinic2 here in the Out-patient
Department of Hillman Hospital (University
of Alabama Hospital) a few years ago for
taking specimens for endometrial biopsis. In
this study we endeavored to get specimens to
determine what type the bleeder was and it is
interesting to note that in 107 patients, we
obtained from one to twenty-five of these
specimens for biopsis, over a period of months
or years. We found that about equal numbers
of these had endometrial proliferation and
progestational phase. Most of these patients
came to the clinic primarily without suspecting
that they had cancer. Of this 107 cases, 15 or
15 per cent had placental tissue. Many had
never been pregnant to their knowledge., This
led us to believe that these cases had been
carrying placental tissue over a period of
years. Of this group (107 cases) 2.8 per cent
had malignancies where none was suspected;
and they were discovered simply by having
endometrial biopsis done. We will show you
the instruments used in taking the specimens
for biopsies at the end of this discussion. If
a malignancy is suspected, always do a com-
plete curettage on the patient. Bleeding often
checks within a short time. In treating these
patients, let’s not give them radium unless
there is a definite indication for it, as this
will cause a disturbance. Hemostasis is the
tirst consideration.
Stilbestrol usually checks the bleeding. Cu-
rettage may be done more than once rather
than give radium. When I think of the drugs
other than penicillin and sulfa drugs, I believe
for the general practitioner stilbestrol is one
of the greatest “Godsends” that has come to
us in treating bleeding. It will check practical-
ly every case of bleeding temporarily. Young
girls who have been bleeding continuously for
as long as six months will usually have a
slowing down of the bleeding within a few
days. It may not correct the condition but will
check the flow. The same thing is true with
adolescents. First, in elderly persons, we should
know what is causing the bleeding for there
may be a “smouldering fire” present — a mal-
lignancy existing. By giving stilbestrol in
these cases, the bleeding is merely stopped.
Stilbestrol will either produce bleeding or
stop it, if given properly.
2. Douglas, Gilbert F. Uterine Bleeding, Study of
107 Cases with Endometrial Biopsies- American
Journal of Obstetrics and Gynecology'. April, 1941,
Vol- 41, pp. 624.
606
April, 1946
Uterine Bleeding — Douglas
In our clinic here, we had stilbestrol furn-
ished us to carry on this study. The only ill
effects seen from it was nausea. We gave
1 to 110 mg. of stilbestrol over a period of
several days. We checked the liver function
and nothing was shown to indicate that stil-
bestrol had any ill effects there.
Radium given in from 200 to 400 mg.
doses may be indicated to control hemorrhage
in the adolescent. We should be leery of giving
it for bleeding in young girls, for it often
causes sterility and permanent damage. It is
much better to do a curettage — one, two, or
three times, over a period of a year or so.
In giving radium 150 to 200 mg. hrs. (one
hundred milligrams of radium applied for one
hour equals 100 mg. hrs.), subjects the pa-
tient to injury to the endometrium. It would
be much better to give x-ray which acts more
on the ovaries. Try to make a diagnosis and
work from the other angle, rather than give
something that would destroy the function.
Uterine bleeding in the child-bearing age is
usually from organic causes rather than func-
tional. Amenorrhea should be differentiated
from infrequent bleeding. Some patients flow
only every three to six months. In making
a diagnosis, organic causes should be ruled
out. An endometrial study should be made
on women past thirty years of age whose
bleeding is irregular. You can take the speci-
mens at the office without giving an anes-
thetic, or one can be given if desired. There
is not much pain to the simple procedure.
Have the patient come back at weekly inter-
vals, so as to study the complete cycle.
Irregular bleeding coincidental with obesity
is not uncommon and is not classified as func-
tional.
Chorionic gonadotropes have no hemostatic
effect. Androgen substance is contraindicated
in treating females. If unable to control bleed-
ing using estrogen, we should be very slow
in prescribing male hormones. This may result
in growing of hair, change of voice, etc., which
may remain permanent. Of the two evils, most
patients would rather have uterine bleeding,
if not malignant, than the male characteris-
tics.
TREATMENT OF UTERINE BLEEDING
The patient should have a complete physical
examination, laboratory tests and basal me-
tabolism. Then rule out any disturbance of an
organic nature or any due to ovarian defi-
ciency.
1. A biopsy gives invaluable information.
In case of menorrhea and metrorrhagia, a
biopsy will rule out malignancy. It will also
determine whether or not the patient is ovu-
lating.
2. Stilbestrol — 1 to 5 mg. three times a day
controls bleeding and usually within three
days bleeding has been slowed down.
3. Complete general examination.
4. Laboratory work — blood counts, hemo-
globin, urinalysis, etc.
Some patients may have hypothyroidism and
should be given thyroid extract and after be-
ing built up to normal will be improved.
NEVER LET A PATIENT COME IN AND
LEAVE YOUR OFFICE WITH BLEEDING
WITHOUT AN EXAMINATION IF SHE IS
SEEKING RELIEF FROM HEMORRHAGE,
EVEN THOUGH SHE MAY BE MENSTRU-
ATING.
I had a patient two years ago who moved
from the North to Tuscaloosa, Alabama. Be-
fore leaving New York state she consulted
her physician and because she was menstruat-
ing, she was not examined. The doctor ad-
vised her to come back. In about three months
she moved to Tuscaloosa and did not go back.
Three months later, making a lapse of time of
about six months, she came to me and an
examination revealed that she had inoperable
carcinoma of the cervix. That happens fre-
quently. Regardless of flow, insist on an exami-
nation. Your responsibility ceases when you
have done all you can. You may find an early
stage carcinoma. INSIST ON SPECULUM
EXAMINATION.
ENDOCRINE PREPARATIONS WITH
MANUFACTURERS
The Anterior Pituitary-Like Hormone
(Prolan) Obtainable from pregnancy urine
or the placenta.
Marketed under trade names:
1. Anterior-Pituitary-Like (A.P.L.) Ayerst,
McKenna and Harrison.
2. Entromone, Endo-Products.
3. Antuitrin-S, Parke-Davis.
4. Pregnyl, Roche-Organon.
5. Follutein, Squibb.
6. Korotrin (Antophysin), Winthrop.
Anterior Pituitary Gland Extraction Products
Marketed under trade names:
April, 1946
607
Uterine Bleeding — Douglas
1. Gonadotropic Factor, Polyansyn, Ovarian-
Anterior Pituitary Liquid. Armour.
2. Gonadotropic Factor, Polyansyn, Growth
Complex, Ayerst-McKenna and Harrison.
3. Prephysin (Anterior-Pituitary Gonado-
tropic Hormone) High Potent Prephysin, Chap-
pel.
4. Pituitary Extract, Anterior Lobe, Lilly.
5. Antuitrin-G, Parke-Davis.
6. Amzinon, Roche-Organon.
7. Gynatrin, Searle.
8. Pituitary Body, Anterior Lobe, Dessicat-
ed, Sharpe and Dohme.
9. Anterior Pituitary Extract, Squibb.
10. Phyone, Wilson Laboratories.
The Estrogenic Hormone.
One ten-thousandth mg. of estrone (the
estrogenic hormone) represents one I. U.
Stated differently .1 mg. of estrone represents
1,000 I.U.
Marketed under trade names:
1. Estrone, Estriol, Abbott.
2. Emmenin, Ayerst-McKenna, and Harrison.
3. Estromone, Endo-Products.
4. Estrone, Estriol, Lilly.
5. Theelin, Theelol, Parke Davis.
6. Estrogenic Hormone, Reed and Carnrick.
7. Menformon, Dimenformen (estradiol).
One rat unit of dimenformon (estradiol) is
equivalent to approximately five I.U. of es-
trone. Dimenformon benzoate (estradiol ben-
zoate). (One International Benzoate Unit of
estradol benzoate represents several times
more activity and more protracted action than
one I.U. of estrone). Roche-Organon.
8. Progynon-B (estradiol benzoate, Pro-
gynon DH is marketed also in ointment as
follows: (a) 200 R.U. per gm. (b) 1,000 R.U.
per gm. Schering.
9. Pro-Follin (estradiol - 17 - propionate)
Schieffelin.
10. Amniotin (Amniotin in oil for nasal ad-
ministration is marketed. Squibb.
The Corpus Luteum Hormone, Progesterone
One International Unit represents one mg.
of chemically pure progesterone.
Marketed under trade names:
1. Lutromone (formerly Lutrone) Endo-
Products.
2. Progestin, Lilly.
3. Lipo-Lutin, Parke Davis.
4. Progestin, Roche-Organon.
5. Proluton, Schering.
6. Progestin, Upjohn.
1 r.
It seems to me if we can get one prepara-
tion that we can use uniformly, we will get
better results than to use more, with which
we are not familiar. Estrogenic hormone —
(one ten-thousandth mg. of estrogen repre-
sents 1 I.U., .1 mg. represents 1,000 I.U. Es-
tromone is the trade name. Corpus luteum
hormone, progesterone, 1 I.U. represents 1 mg.
of chemically pure progesterone.
I mention those so that you will know that
there is very little difference in these prepara-
tions. Presumably they are all the same if
properly standardized. If not standardized, we
should not use them. They are being checked
by the government and if we can get one
that can be used uniformly, it will be better.
MALIGNANCIES THAT CAUSE UTERINE
BLEEDING
Early malignancy of the cervix which would
probably be squamous cell carcinoma occurs
on the surface of the cervix. There are two
groups to think of in considering these.
1. Clinical group.
When you find a little spot on the cervix
do not take it for granted. It may be that
it is non-malignant, but treat as such until
proved otherwise for it may be Grade 1 car-
carcinoma. Grade 2 clinically extends farther
into the cervical tissue toward the bladder.
Grade 3, where broken through into the peri-
toneum or base of bladder. Grade 4 extends
pretty well into the body of the uterus and
adnexae.
2. Microscopic Group.
A report from the pathologist will show the
grade in this group, 1, 2, 3, or 4, indicating
the activity of the cells themselves.
Frequently we find that a number of pa-
tients come in with uterine bleeding and on
examination with speculum nothing can be
seen, no erosion on the surface of the cervix.
They may bleed more with menstruation, but
frequently there will be an early malignancy
invading the lining of the canal, which might
be adenocarcinoma of the cervix, involving
glands. Grade 1 is easily overlooked.
Group 1. Malignancy of Fundus. Adenocar-
cinoma usually starts in the glands. Certain
amount of bleeding is present. Diagnosis
would not be made on bimanual examination.
It is better to give an anesthetic and do a
complete curettage. 11 case bleeding continues
608
Uterine Bleeding — Douglas
April, 1946
after examination then give x-ray or radium
or both and follow with surgery.
Group 2. Further invasion.
Group 3. Still further invasion — still with-
in the capsule.
Group 4. More serious and further ad-
vanced extending beyond the peritoneal cover-
ing. Never fail to do a speculum examination
if you expect to accomplish the most.
ROUND-TABLE DISCUSSION
Question: What advantage has stilbestrol
over some of the improved products ?
Dr. Douglas: Dr. McDowell, will you answer
this question?
©r. McDowell: Stilbestrol has been used ex-
tensively and some of the first work was done
here on the original stilbestrol before it was
actually put on the market. Dr. Douglas was
doing some work here on endometrial biopsies
and we obtained a supply of stilbestrol from
one of the chemical houses. I do not think
• "’bestrol is the best that can be used or that
i4: ..as proved to be perfect preparation, be-
cause it has been so misused. Many doctors
use stilbestrol in general work and those who
do gynecologic work think all we have to do
is give a little stilbestrol and calm the symp-
toms down, Unless stilbestrol is very greatly
controlled, the treatment is sometimes worse
than the disease in that the patients will be
improved for a short period and if stilbestrol
is continued, will get bleeding from the ori-
ginal cause. I personally feel that natural es-
trogenic substances if given by mouth would
be better. If stilbestrol is used, do not give
very large doses. Bleeding can be controlled by
as little as 1/5 mg. dose a day. Originally
1 to 5 mg. were given, but 1/2 to 1/5 mg. will
control symptoms in the treatment of meno-
pause.
Question: (Should stilbestrol be given in
cycles rather than straight through the peri-
od?
Dr. Douglas: Dr. McDowell, will you answer
this question ?
Dr. McDowell : If we are going i to use any
of the hormone products, we should try to
simulate what the body is doing or should do.
If we are using stilbestrol, we should try to
give it in the same order that the ovaries
would produce. Estrogen substance is produced
' • J&: ■, . ..
during the entire period. After about twelve
to fourteen days progesterone takes over. If
you are going to use stilbestrol it should be
given cyclically. Give it for two weeks, then
stop and if possible substitute corpus luteum
hormone for two weeks and then give stilbes-
trol again. This is now the accepted way,
rather than through the entire cycle. Many
women in menopause are treated with estro-
genic substances and are over-treated. In our
own cases here, we had many" patients who
were over-treated because we did not know
the dosage and gave it through the cycle,
which resulted in bleeding from over-stimula-
tion of the endometrium.
Question: Isn’t obesity caused by endocrine
imbalance associated with uterine bleeding?
Dr. Douglas: Dr. Norton, will you answer
this question?
Dr. Norton: We might say it is often from
endocrine imbalance. Obesity is one thing a-
bout which no department of medicine knows
too much, as well as menstrual disturbances.
If we cannot find any organic cause for uter-
ine bleeding, which would also cause obesity
and if we cannot identify the cause, then that
obesity is considered endocrine in nature but
I don’t see how we can prove it.
Question: Does odor have any particular sig-
nificance as to type or cause of bleeding?
Dr. Douglas: Dr. McDowell, please answer
this question.
Dr. McDowell: As far as I know, I don’t
think so, unless there is a malignancy due to
breaking down of tissue which has a character-
istic odor. I do feel, however, that gonorrhea
in many instances will produce a definite odor
that sometimes can make the diagnosis before
you look at the smear. The patient’s standard
of hygiene has something to do with it. Con-
dylomata will produce a fairly characteristic
odor. Then there is a very definite type of
odor that ordinarily goes with a bladder con-
dition.
Question: Do you use theelin rather than
some other preparation?
Dr. Douglas: Dr. Norton, will you answer
this question?
Dr. Norton: Theelin is rather expensive and
requires the patient to come in for hypoderm-
ic injections. Stilbestrol is considered by many
as the treatment of choice.
April, 1946
609
Question: What dose of stilbestrol causes
bleeding and what stops bleeding?
Dr. Douglas: Dr. McDowell, will you answer
this question?
Dr. McDowell: We found that we were over-
treating some women. Some in the menopause
were still bleeding regularly or not bleeding
at all. We used it originally hypodermically 5
mg. and after subjective symptoms were re-
lieved, dropped to 1 mg. We should remember
that each individual is different. One will
react more completely than another. We found
it best to use relatively small doses — J mg.
It may cause bleeding or hyperplasia of en-
dometrium. Building up the dose will stop the
bleeding. If increased too much, some of the
endometrium will slough off and open up small
vessels and bleeding will start again. Some-
times if stilbestrol is stopped, again sloughing
off occurs and causes bleeding “of withdraw-
al.”
Question: Should estrogen and progesterone
be given at the same time?
Dr. Douglas: Dr. Norton, will you answer
this question?
Dr. Norton: Estrogen only in the first half
of cycle. During the second half give both.
In line with this, Hamblin at Duke gives es-
trogen first and says that progesterone has
no effect except in the last half of the cycle,
which is preferable. If the patient comes in
during the second half of the cycle, the best
idea is to go ahead and start estrogen for
two weeks and then progesterone.
Question: What of dysmenorrhea in an
otherwise healthy girl with no organic disease ?
Dr. Douglas: Dr. McDowell, will you answer
this question?
Dr. McDowell: I think she should have a
cervical dilatation with or without curettage.
May have cervical stenosis or some blockage
or it may be psychogenic.
PROCEDURE OF OBTAINING SPECIMEN
FOR ENDOMETRIAL BIOPSY IN
OFFICE WITH DEMONSTRATION
OF INSTRUMENTS USED
There are many different instruments — Ran-
dall, Burch, Novak, etc. In the endometrial
biopsy clinic we used the Novak suction cu-
rette. It has a little fenestrum on the curved
side, with little teeth. The instrument is
small enough to slip into the uterine
cavity without dilating the cervix. Then by
firm pressure and by drawing back and forth
the physician can break off enough of the
endometrium to get a good sized specimen.
It can be used with a 5 or 10 cc. syringe.
Catch the cervix with a tenaculum forcep,
then slip this instrument into the uterine cavi-
ty. Judge how much pressure to use. Connect
tubing with a cut-off to a specimen bottle.
After getting tissue by back and forth move-
ments as if curetting, withdraw curet and
suck a solution of sodium citrate through the
tubing so as to get all particles of tissue out.
The citrate also prevents clotting of blood.
Then take a piece of gauze and put over
the top of the bottle and tilt it over so as
to get all out. Transfer the little pieces of
tissue onto a piece of filter paper. Hamblen
uses the Burch instrument and gets little
bites, which he takes at weekly intervals.
We used in our study the Novak in most in-
stances, but either is all right.
Believe me, every man has his secret sor-
rows, which the world knows not; and often-
times we call a man cold when he is only sad.
— Longfellow
We must be free or die who speak the tongue
That Shakespeare spoke, the faith and morals
hold
Which Milton held.
— Wordsworth
^ y : f -The Modern Treatment of Burns
James A: Valohfe, M.S. (Surg) Capt., M.C.
Chief of General iSurgery
Station Hospital, Camp Shelby, Mississippi
r— - very fifteen minutes of the day, twenty-
I— four hours long, an ambulance comes
screeching down a city street carrying one
burn victim. But the hurry and rush is fu-
tile because that particular patient is doomed
to die ! One person dies of burns every fifty
minutes, approximately 10,000 victims per
year' There hire thousands suffering from the
after effects, maimed and deformed sufficient-
ly to be ostracized socially and economically;
we have all seen contractures of joints, fin-
gers and Unsightly disfiguring of the face. We
are excluding the economic loss since this is
very difficult to determine or assess, as is the
physical suffering associated with the burn
itself.
Until rather recently, the treatment of burns
was confined to its local therapy, and this
mostly for comfort. It has long been known
that salves and ointments are comforting to
the patient and serve as local analgesics. There
were two reasons for this passive attitude
toward burns: First, everybody knew, or at
least thought, that if one-third of the total
body surface is involved, the victim’s prog-
nosis is poor, and he probably would die de-
spite any therapy; secondly, we can not pre-
vent infectiou except by local ..protection by
such emollients as vaseline. If a patient de-
veloped secondary infection and secondary
contractures, that was more or less inevit-
able, at least he didn’t die. . t :
We can safely say that the late Dr. David-
son was the father of the modern treatment of.
burns. Tannic acid, which he advocated, has
been discarded almost completely, but he gave-
burn research a terrific impetus and rf or the
first time we started to treat the patient sys-
temically as well as locally. He proves, be-
yond a doubt, that the initial shock associ-
ated with severe burns is due to fluid loss,
carrying with it electrolytes. Saline and glu-
cose therapy was the fad through 1940, at
least for systemic treatment, to prevent
shock and secondary toxemia. Periodic red
blood counts were done to determine the con-
centration of blood. Blood chloride determina-
tions were also done at frequent intervals.
Locally, the tannic acid coat was helpful,
supposedly, by fixing the burn toxin in the
skin, preventing it from being absorbed into
the systemic circulation. In reality, the treat-
ment of the burned area before applying tan-
nin was the big factor in preventing the tox-
emia and infection in these cases. He advo-
cated treating the burn as a surgical wound.
All blebs, blisters and dead skin were de-
brided; this was done by attendants who
scrubbed as for any other major operation,
wore masks, caps and sterile gowns. This pro-
cedure cut down considerably the incidence
of secondary infection. Temperature of the
room, or heat cradle, was approximated to
body heat, approximately 75° to 85° Fahren-
heit.
With the advent of the sulfa drugs, a new
weapon became available, but it vsras not long
before we learned that severe burn patients
were poor candidates for sulfa drug therapy.
The urinary output in these major cases is
usually low and the patient dehydrates. Fur-
thermore, we learned that severe bum cases
ending fatally revealed central necrosis of the
liver and kidneys, so chemotherapy had to be
used with caution. The Coconut Grove studies
were equivocal with regard to their efficiency
in preventing infection.
About >1938, Henry Harkins showed that a
burned extremity actually increases in size
and volume find that this increased volume is
due to the accumulation of fluid-tissue fluid,
fluid representing more than serum, contain-
ing proteins which are normally found in the
circulating blood stream. After analyzing
the blood protein in burn victims he found a
depletion of plasma proteins. He further
proved the point by measuring the ratio of
blood cells to plasma. This is easily done by
allowing a test tube of blood to stand, allow-
ing the cells to settle to the bottom and meas-
uring the supernatant liquid. Normal blood
shows a. cell volume of 45 per cent, with hemo-
globin concentration the volume increases to
55 per cent aid 70 per cent, and even higher.
■Shock experiment gave the same blood
changes. Therefore, it was assumed that hem-
oconcentration is the direct cause of shock in
Treatment of Burns — Valone 611
mediate dermatome split thickness grafts. The
April, x946
burn cases. Therefore, if severe burn cases
could be carried, through this critical period,
namely the first twenty-four to forty-eight
hours following the accident, by adequate
treatment, the first great cause of death
would be removed. Plasma replacement ther-
apy proved its value by effectively eliminat-
ing the shock. The extent of plasma loss and
the burned area is proportional directly to
the depth and the extent of the area or areas
of capillaries involved. Shock studies revealed
that capillary permeability following endothe-
lial injury can be reduced by the administra-
tion of adrenal cortex extract. This tends to
prevent shock by cutting down the plasma
loss from the circulating fluid. This extract
has been put on the market under the trade
name of eschatin or desoxycorticosterone and
its dosages must be sufficient, 5 cc. four
times daily for seventy-two hours. Dosages
of this extract measured in minims are in-
adequate and might just as well be used as
a hair tonic.
Infection, the second cause of death and/or
morbidity, is best controlled by penicillin par-
enterally. The sulfa drugs did not prove their
worth in the Coconut Grove disaster. Penicil-
lin must be given in large doses, 40,000 to
50,000 units every three hours. Larger than
average doses are necessary to prevent local
infection. Average doses will prevent septicemia,
pneumonia, and kidney infection. Toxic ef-
fects for penicillin are rare and not serious.
Once the patient is carried through the
critical period of the first twentyifour to
thirty-six hours, the surgeon’s attention can
be focused on the burned tissue and treat
this as a surgical wound. Extremities are de-
brided so that no debris remains, sterife vase-
line strips are applied, then followed by sterile
gauze and in turn by cotton mechanic’s waste
for pressure and elastic bandage applied ex-
ternally. The chest and abdomen are treated
the same way, though with more difficulty.
These dressings need not be changed until
drainage and soiling, or discomfort, make it
necessary. As a rule the first change is not
necessary until eight to ten days have elapsed.
Burns about the face and neck can be
treated the same way provided the burn is a
first or second degree burn, therefore as-
suring good epithelialization, without scar tis-
sue formation. Deep third degree burns about
the face and neck should be grafted very early
and some are even grafting these parts by im-
longer you wait for grafting, the greater the
underlying fibroblastic proliferation and scar
tissue formation. y
Burns about the axilla, elbows, neck and
popliteal fossa present the added problem of
contracture formation. These joints should be
placed in optimum position from the very be-
ginning and splinted in this attitude if neces-
sary.
The following drugs and procedure have
proved their merit in the treatment of burns
and will be remunerated for emphasis:
1. Morphine in adequate doses for the first
twenty-four hours and given intravenously if
necessary.
2. Debridement of the surgical wound using
sterile technique, including a scrub-up, rubber
gloves, masks and gowns. The mask is most
important. Our surgical infections come from
the nose and not from the hands unless the
surgeon habitually picks his nose.
3. A severe bum is a perfect indication for
plasma replacement therapy. Whole blood is
not indicated the first twenty-four to forty-
eight hours. Contrary to popular thought, or
belief, too much plasma can be given and
manifest itself by pulmonary edema. The rule
to follow is 50 cc. plasma for every 1 per cent
of body bum provided the burn is a second
or third degree in depth. This rule holds
for adults and must be modified for children.
Therefore, a 30 per cent involvement of the
body would require 1500 cc. of plasma. This
should be given in a relatively short period of
time or twelve hours, and two-thirds of the
total amount should be given the first six
hours. Let the hematocrit be your guide. Give
glucose 5 per cent for hydration and to stim-
ulate urinary output to 1000 cc. daily.
4. Glucose 5 per cent or 10 per cent to in-
sure adequate urinary ouput. If a blood chlor-
ide can not be done for guidance, look for
pretibial edema and glossiness of the skin.
Whole blood is indicated after forty-eight
hours. In severe burn cases, when the stage
of toxemia is present, they generally become
anemic and run a low hemoglobin and RBS.
5. Adrenal cortex extract, 5 cc. every four
hours for twenty-four to forty-eight hours.
6. Tetanus antitoxin, 1500 units.
7. Penicillin, 40,000 to 50,000 units every
three hours to prevent secondary infection.
8. Penicillin locally if infection develops de-
612
Treatment of Burns — Valone
April, 1946
spite parenteral penicillin.
9. Pressure vaseline dressing locally.
10. Prevent contractures about joints by
correct positioning.
The following charts represent the dis-
turbed physiology in severe or major burns
and will be reviewed to clarify the treatment
indicated. The treatment of a major burn
will be reviewed, dividing it in periods such as :
The first hour, the first forty-eight hours,
second to fifth day, etc. The treatment will
be subdivided into general or systemic treat-
ment, local therapy and laboratory determina-
tions to check pathologic physiology.
HEMATOCRIT DETERMINATION
(o% 7*c.
A"*V Y-.* I
5fe«rere J? </*•»% or ft
Hence, the extreme importance of knowing
this determination and subsequent follow-ups
to indicate the cessation of treatment. Al-
ways remember that too much can be giVen
and not enough may let the patient go into
shock !
First Aid Method: For each ten per cent
(10 per cent of body surface involved by a
deep burn) 500 cc. of plasma should be given.
The amount of plasma indicated should be
administered within the first twelve hours fol-
lowing the accident by a continuous intra-
venous drip.
METHODS OF CALCULATING PLASMA
DOSAGE
HARKIN’ S METHOD:
Give 100 cc. of plasma for every point that
the hematocrit determination exceeds the normal
of 45.
FIRST-AID METHOD:
For each 10 per cent of body surface in-
volved by a deep burn, 500 cc. of plasma should
be given.
Chart No. 3 — After determining the extent of skin
involved we can easily calculate the dosage of plas-
ma indicated.
Chart No- 1 — Test tube (a) represents a nor-
mal blood hematocrit plus 45 per cent blood cell
volume 55 per cent plasma.
Test tube (2) represents a blood hematocrit in a
moderately severe burn four to six hours following
the accident. (Sixty per cent blood cell volume and
40 per cent plasma.)
BERKOW’iS METHOD FOR ESTIMATING
EXTENT OF BURNED AREA
Region Per Cent Body
Involved
HEAD 6 per cent
UPPER EXTREMITIES :
Both Arms and Forearms
Both Hands
TRUNK:
Anterior Surface
Posterior Surface
14 per cent
4-5 per cent
20 per cent
18 per cent
LOWER EXTREMITIES:
Both Thighs 19 per cent
Both Legs 14 per cent
Both Feet 6 per cent
Chart No- 2 — A chart from Berkow's method for
estimating area involved.
Harkin’s Method: Give 100 cc. of plasma
for every point that the hematocrit determi-
nation exceeds the normal of 45.
Chart No. 4 — .This represents the changes in the
blood chemistry and its physical composition in a
severe burn case. Note the high hematocrit reading
and depleted blood proteins wiithin a short time fol-
lowing the trauma.
Plasma therapy has been started to correct the
pathological chemistry and desoxycorticosterone was
administered, 5 cc. every four hours.
Within seventy-two hours the hematocrit and
plasma protein concentration are approaching their
normal levels-
O
PLASMA VOLUME
•
PLASMA PROTEIN
613
April, 1946
i 1 1 • i :
Chart No. 5 — The converse of the above Chart No. 4
is represented in the same severe burn case showing
the depletion of circulating- plasma volume and plas-
ma protein.
The objective of plasma replacement therapy and
adrenal cortex administrations is obtained in ninety-
six hours.
The dip in the curve at the twenty -foui’-hour in-
terval may be due to temporary stoppage of plasma
infusion.
Timing is very important in the treatment
of burns. Everyone has seen energetic and
ambitious interns start extensive debridement
of wounds or a burn before evaluating the
general condition of the patient and strength
of his vital signs. After all, we want a living
patient and not a dead one with meticulously
clean burn wounds. We, therefore, analyze
the treatment by intervals of time following
the accident and divide it into three catego-
ries: General treatment, Local treatment and
Laboratory.
TREATMENT — PRESSURE DRESSING —
MAJOR BURNS
First Hour
General Treatment Local
1. Morophine sulphate
2- I. V. Infusionsof plasma.
3. External heat
4. Oxygen for
shock.
75 to 85° F.
Delay until shock
under control.
Labox-atory
1. Hematocrit
2. Plasma pro-
teins
3. Red blood
count and HBG
4. Urinalysis
Chart No. 6 — Morphine must be given in adequate
dosages up to gr- one-fourth to one-half qr. Dos-
ages can be given inti'avenously unless the patient
is in shock. Acute morphinism conti’ibutes to cere-
bral anoxia and should be avoided in shock.
NOTE: Local treatment is .delayed until shock
is under control-
Hematocrits are taken every four hours as in
RBC and HBG- Plasma pioteins and urinalysis at
twenty-four intervals. 1
FIRST 48 HOURS
General Treatment Local Laboratory
1. Continue Mor- 1- Debridement of 1. Hematocrit
phine P. R. N. burn Q4H
2. Adrenal cortex 2. Open blebs or 2. Urinalysis.
blisters
3- Plasma as indi- 3. Apply Vase-
cated by Hemato- line gauze plus
crit pressure dressing
4. Glucose & Sa- 4- Positioning of
line P. RR. N. joints-
5. Penicillin 40,-
000 q 3 h. Clinical data
T. P. R. and blood pressure frequently. Record urin-
ary output-
Char\t No. 7 — In addition to treatment indicated
on Chart No. 6, adrenal cortex extract and penicillin
parenterally are started-
Only large doses of the latter, 50,000 every -three
hours, will prevent local infection.
Shdck will have been overcome after forty-eight
hours and local treatment started and pressure
dressings of vaseline applied.
Laboratory data can be cui-tailed after forty-eight
hours.
SECOND TO FIFTH DAY
General treatment Local
Laboratory
1. Morphine or No dressing
Barbiturates changes
2- Penicillin continued.
3- Glucose & Saline as
indicated
4. Fluids by mouth
5. Diet - high protein and
cho
1. Daily
Hematocrit
HBG
Plasma Protein
CBC
Blood Sugar
NPN
Urinalysis
Chart No- 8 — Patients are usually comfortable in
this period with vaseline dressings. High protein
diet is started to combat secondary anemia which
is common after the first week.
Locally — No treatment is necessary except for
comfort to the patient-
Daily complete blood counts and hemoglobin are
important from now until all wounds are healed-
SIXTH TO FOURTEENTH DAY
General treatment Local Laboratory
1. Sedatives 1- Superficial 1. Daily
burns healed.
2. Whole blood for 2. Deep burns db- HBG
secondary anemiabrided and graft- Complete blood
ed when pos- fc'ount
sible.
614
Cancer — Dicks
April, 1946
3. High vitamin 3- Reapply pres- NPN
diet. sure dressing P- Urinalysis
R. N.
4. Local penicil-
lin ointment for
infection;
Chart No- 9 — Whole blood transfusions are im-
portant during the second week.
The local treatment will demand primary atten-
tion. All superficially burned areas will have healed
on first change of dressing. Deeper wounds will
require debriding and skin grafts when the recipient
area is ready.
When local infection develops despite parenteral
locality, penicillin ointment will prove of value.
HEALING PERIOD— SECOND TO FOURTH
WEEK
General treatment Local Laboratory
1. Periodic blood 1- Change dress- 1- CBC twice
transfusions ing weekly for weekly
deep burns.
2. Vitamin 2. Skin grafting 2- Daily urin-
therapy as necessary alysis
Chart No. 10 — Vitamin therapy, especially ascor-
bic acid, will aid healing and multi-vitamin prepara-
tion by mouth will be adequate.
The dressings are changed as necessary as the
appearance of the wounds will dictate and areas
grafted when clean and ready for new skin.
Daily urinalysis and periodic complete blood
counts are the only laboratory data necessary.
The treatment of major burns is arduous
and painstaking, requiring a doctor skilled
both as a physician and surgeon. First, a
physician must understand the care of a se-
riously ill individual, sick not only physically
but mentally. Psychic trauma may actually
be more serious than the wound. Secondly,
considerable surgical skill is required in treat-
ing a burn wound which may heal with or
without complications or deformity. On the
other hand, he may have to prepare the wound
for plastic surgery. The right treatment at
the right time may very well be the theme of
the surgeon-in-oharge.
These cases require constant nursing and
adequate care may demand a special nurse.
The laboratory studies mentioned may seem
multiple and cumbersome but can be done by
most laboratories.
Severe burns have been and continue to be
a challenge to our profession. We are
equipped to cope with such catastrophes,
thanks to the research of American surgeons.
To apply ourselves is all that remains.
The General Practitioner In the Cancer Program*
GEORGE D. DICKS, M. D.
Natchez, Miss.
I feel the temerity of a mere beginner in
practice as I approach the problem of the gen-
eral practitioner in the cancer program. Yet
I am not without hope that this and similar
discussions may so stimulate and provoke our
thinking as to give us a newer and fresher
perspective of an age-old question.
To consider the role of the general prac-
titioner in the cancer program, let me review
briefly the principal objectives of the Amer-
ican Cancer Society :
1. Cancer education.
2. Cancer study.
3. Cancer diagnosis and treatment.
The general practitioner is an indissoluble
part of the plan of attainment of each one
*Read before the Tri-County Medical Society,
February 26, 1946.
of these objectives. Militarily speaking, he
is in the most forward medical echelon and it
may well be on his individual and coopera-
tive efforts that a large measure of the suc-
cess or failure of this program depends. I
do not intend to minimize one whit the im-
portance of any other contribution to this
work, or to infer that the general practitioner
occupies a more elevated position in this pro-
gram; but I do mean to emphasize — and em-
phasize to that practitioner himself — the real-
ization of the value of his own work.
Consciously or unconsciously, most of us
are conducting some sort of educational pro-
gram with our patients almost daily. Cer-
tainly the opportunities for guiding the lay
understanding of the problem of cancer are
frequent. Most educators will no doubt tell
you that mass education is a difficult and ex-
asperating thing with a sort of Utopian tinge
April, 1946
Cancer — Dicks
615
to the idea; but yet, if these efforts on our
part bring to light one or more cancer cases,
even one additional cancer suspect, then I be-
lieve them worthwhile. There is no need to
try to develop cancer phobias in our patients.
We have enough phobias of other kinds with-
out that. We can, however, take advantage
of every chance to offer simple, clear expla-
nations of and develop understandable ap-
proaches to cancer thinking. The effect on
your own understanding will be surprising.
For those of us who have the ability, in-
terest, and circumstances there will be devel-
oped many possibilities for the specific study
of cancer, as outlined in the second objective.
Of this objective alone I shall have little to
say. Broadly speaking, and from the general
practitioner’s standpoint, it is essentially a
part of the third and most important objec-
tive— diagnosis and treatment.
Historically speaking, our problems in the
field of cancer diagnosis and treatment come
to us from out of the mists of the past — from
the realms of antiquity. Throughout those
many years, and especially in the last decade,
many important discoveries have been made.
Our knowledge has been immeasurably in-
creased. But let us not be smug about that.
There is one specific, dynamic problem which
is with us yet, although it forms the bed-
rock on which diagnosis and treatment rest.
It is a problem that is with us continually. I
refer to the problem of scientific curiosity.
You may wonder why I speak of this as a
problem. Surely we must be considered to
have a certain amount of such curiosity to be
called any sort of doctor of medicine. That is
very true; but, honestly now, how consistent-
ly do you practice that trait?
I think of no field of medicine which more
justly calls for persistent scientific curiosity
than the field of neoplastic disease. In the
parade of patients through any general prac-
titioner’s office come the signs and symptoms
of many and varied conditions — general med-
ical, surgical, obstetrical, gynecological, pedi-
atric, etc. From that broad outlook comes
much that is trivial ; a more modest amount
that is serious. It is no easy job always 10
sift apart the trivial from the serious. Many
of the serious conditions may be overlooked,
no matter how sincerely or honestly we may
try. The early signs and symptoms of neo-
plastic growths do not always come with
specimen labels on them. But remember
this — it is only through the continual and per-
sistent stimulation of our curiosity that we
may hope to make any real progress in the
approach to the problem of cancer.
The ultimate diagnosis of many — indeed,
perhaps most — cases of cancer will fall into
hands other than yours. Some of the cases
you may never see, their discovery and treat-
ment originating in special clinics or in the
hands of specialists. But a larger share of
these discovered cases should and will origi-
nate in your hands — if you will but maintain
a rigorously inquisitive mind toward every-
thing your five senses or even that sixth sense,
horse sense, may tell you. Above all, take
nothing for granted. That eroded cervix you
saw yesterday — did you really look at it close-
ly, or did you take it for granted! That more
frequently recurrent constipation of old Mr.
Smith — did you pay much attention to that
part of his story, or did you take .it for
granted? That indolent ulcer on the back of
the hand — did you logically explain its per-
sistency, or did you take it for granted? Again
I reiterate, the continual application of inqui-
sitiveness is the primary starting point of the
part of the general practitioner in this pro-
gram.
I make no plea for early diagnosis. Its im-
plication in any diagnosis of neoplasm is too
obvious to require explanation or exposition
here. What I do urge upon each and every
one of you is a vital consciousness of his part
in this work; an honest appraisal of your
scientific curiosity. It is but one part you
will play in the total effort but the founda-
tion of its success and its cooperative attain-
ment of the common goal will arise out of
nothing less than the constant fanning of the
flame of curiosity.
Recapitulating simply, the general practi-
tioner has a real responsibility in every phase
of the drive against cancer — a responsibility
which I am certain he will discharge with
every ability at his command. Yet, in the
accomplishment of that privilege, I would
caution him — and every other person no mat-
ter how lofty to be his intellectual brow — to
remember the words of Thomas Henry Hux-
ley to “sit down before fact as a little child,
be prepared to give up every preconceived no-
tion, follow humbly wherever and to what-
ever abysses nature leads, or you shall learn
nothing.”
Cancer versus Physicians and the Public
A. L. Gray, M.D.
Director of Division of Preventable Disease
Control, Mississippi State Board of
Health, Jackson, Miss.
ncrease in the number of deaths due
to cancer at once suggests a greater de-
gree of activity on the part of private
physicians, public health workers, and the
public in general.
Judging from the present rate of deaths
from cancer in Mississippi one person in seven
or eight will have the disease and most of
those having it will die because of it. It is
well known that one-third to one-half of
those now dying of cancer could recover if
present facts about cancer were applied to
the fullest extent. As in all other things
medical in nature, the responsibility of mak-
ing this knowledge work for the benefit of
Mississippians rests first squarely with the
physicians of the state, and, second, with pub-
lic health workers. These two groups of peo-
ple, with the organizational, educational, and
fund-raising facilities of the Mississippi div-
vision of the American Cancer Society and its
component county organizations must see to
it that six to eight hundred of the total of
sixteen hundred deaths caused by cancer each
year in Mississippi do not occur.
Many things can and must be done. First,
when people know, as they must know, the
facts about cancer, they will go to their phy-
sicians for help at a time when something
can be done. This means that the American
Cancer Society, public health workers, and
physicians have much to do in informing the
public about early signs of cancer and the
need for immediate action upon appearance of
these signs. Then, when those who have sus-
pected cancer report to physicians, the physi-
cians must have a high index of suspicion and
a refreshed knowledge and make certain that
the condition is or is not cancer. When this
determination is made and cancer is diag-
nosed, all known effective methods of cure
must be made available by private physicians
and public institutions. These should be our
aims.
This education, organization, and treatment
will require money. The money must come
first, from those who have cancer, through
the private physician-tpatient relationship.
Second, it must come through public subscrip-
tion to the state and local units of the Amer-
ican Cancer Society as a result of acquain-
tance with the need. Third, such funds must
come through channels of taxation. The
funds from the latter sources will be used to
pay private physicians for services for which
cancer suspects and cases cannot pay and for
providing educational, diagnostic, and treat-
ment facilities which the private physicians
are in position to provide.
616
April, 1946
Editorials
617
The M-ississippi Doctor
Published monthly at Booneville, Mississippi-
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner- It champions the community hospital, the
hub around which this service must be built.
W. H. ANDERSON, M.D- Editor-in-Chief
MILDRED P- ANDERSON Assistant Editor
David E- Guyton, Blue Mountain College Poet
C. H. Lutterloh, M. D President
Hot Springs, Ark-
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn-
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M- D Vice-President
El Dorado, Ark.
A. F. Cooper, M. D Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M- D Director of Exhibits
Memphis, Tenn.
E. M. Holder, M. D. C. R. Crutchfield, M- D.
F. M. Acree, M- D. H. King Wade, M. D.
Lawrence W. Long, M-D.
J G. Archer, M.D. W- Lauch Hughes, M.D.
Manuscripts and material for publication under the
Mississippi State Medical Association should be re-
ceived not later than the twentieth of the month
preceding publication. Address material to Lawrence
W. Long, M-D., Suite 412 Standard Life Building,
Jackson, Mississiippi.
STATE MEETING
The Mississippi State Medical Association
holds its annual session this year at the
Robert E. Lee Hotel in Jackson, May 14 and
15. Dr. Lampton Crawford of Tylertown is
the honored president. He is worthy and well
qualified for this honor, having served his
people well as a general surgeon in a small
town and as a fine Christian citizen. Dr. J.
K. Avent of Grenada, another general surgeon
whose service is also broadened by an active
civic mindedness, is president-elect. Dr. Tom
Dye remains the faithful and popular secretary.
The subject of the president’s address on
Tuesday night is “Medical Progress in the
Twentieth Century”. Dr. M. Y. Dabney of
Birmingham, president of the Southern Medi-
cal Association, will deliver the annual ora-
tion on the subject, “Unusual events in Medi-
cal History”, and Dr. J. P. Wall of Jackson
will speak on “What Socialized Medicine Means
to Mississippi”.
Dr. A. B. Harvey of Tylertown is chair-
man of the Section on Surgery. Out of town
essayists for this section are: Doctors Alton
Ochsner and Curtis Tyrone of New Orleans
their subjects being “The Doctor’s Cancer” and
“Menopausal Bleeding”, respectively. This sec-
tion meets Wednesday morning.
The sections on Hygiene and Public Health
and Eye, Ear, Nose and Throat hold their
sessions Tuesday afternoon, with Dr. Paul
Haney of Laurel as chairman of the first, and
Dr. S. B. Caruthers of Grenada, chairman of
the other. Edwin S. Kagg of New Orleans is
the guest public health essayist, while Drs.
Samuel B. Nadler of New Orleans, Jack S.
Guyton of Baltimore, and Gilbert E. Fisher of
Birmingham are Eye, Ear, Nose and Throat
Section guests.
Dr. H. C. Sheffield of Jackson is chairman
of the Section on Medicine for Wednesday
afternoon. He has arranged a strong program,
with Carl F. Vilter of Cincinnati and Frank
F. Whitacre of Memphis as out-of-state es-
sayists.
The House of Delegates will meet Tuesday
morning at nine o’clock and again on Wednes-
day evening at seven-thirty.
The past-presidents of the Central Medical
Society will give a breakfast as seven-thirty
Tuesday morning at the Robert E. Lee for
all state past-presidents. Section luncheons are
at one on Wednesday. The Half Century Club,
composed of all doctors who have been prac-
tising for fifty years, will be given a dinner
on Tuesday evening, beginning at five-thirty.
The Woman’s Auxiliary will hold its an-
nual session with Mrs. L. J. Clark of Vicks-
burg as president and Mrs. Stanley Hill of
Corinth as president-elect. This valued asset
to the Association has arranged a nice pro-
gram and splendid entertainment.
It will take a little time to get back in
full swing in our state meeting, but we will
really get on the way at the coming meeting.
Mississippi has before it a new era in medi-
cal service and it behooves us to be wide-a-
wake and to go forward.
618
Editorials
April, 1946
With Dr. Lampton Crawford as president
and Dr. J. A. Avent as president-elect, at
the coming meeting we will proceed accord-
ing to the year of last elections.
Be sure to visit the commercial exhibits of
one and all at our state meeting. We are glad
to have these exhibitors with us. They are
anxious to serve and want to cooperate with
the medical profession. We should cooperate
for the good of all concerned. Dr. Dudley
Jones has the exhibits in charge and he always
does a good job of it.
Our four-year medical school and our af-
filiated hospital should be on the way at an
early date so that the medical service to our
people may soon be more efficient. They must
go hand in hand if the people are to receive
the best medical service. Interns may serve
part time in the small hospitals, iand nurses
may train part time in the small hospitals.
Resident doctors may come out to the small
hospitals for some of their work also.
It will take a little time, but our state
medical association will soon get back into
the swing. It has rendered a great service in
the past and we predict a still greater work
in the future.
The Southern Medical Association instituted
a “public night” several years ago, its pur-
pose being to bring valuable information and
inspiration to both the medical profession and
the laity and to promote a better understand-
ing between the doctors and the people. It
has proved a great success. Just before the
war this plan was adopted for our State
Medical Association. One such meeting was
held and partially another. They were a suc-
cess. We believe this public night should be
a part of the state program. There needs to
be a better understanding between the profes-
sion and the laity and this is a good way to
promote it.
The death of Dr. Fred M. Sandifer of Green-
Ivood, who died at the age of sixty-eight on
April 19, is widely lamented.
Beware of tumors. The benign tumor us-
ually has a capsule around it, but the malig-
nant one is usually irregular in shape and has
no clearly defined boundary.
RESUMPTION OF OUR ANNUAL MEETING
Now that the shooting war is over, the
Mississippi State Medical Association will meet
again for its annual convention. In conforming
to the requests of the federal government,
there were no annual meetings held while
travel and shipping was so vital to the war
effort. This spring finds us with the majority
of our members returned from the Armed
Forces, and the four corners of the globe.
Most of them have become readjusted and
resettled into civilian practice, and the people
of our state should be able to receive more
prompt medical and surgical care than during
the pressing days of the global war. Then,
too, the physicians and surgeons who served
so well, so faithfully, and long hours without
rest, should now be given a “breathing spell”
to readjust themselves and devote more time
to study, reading and recording of the un-
usual events that will be of interest to the
medical profession in general.
The program of the state meeting is an
outstanding one with very able talent from
afar and at home expounding the facts and
wisdom from which we will all benefit. Plans
are being made by the Central Medical Society
to receive a large attendance. Mississippi medi-
cine should advance more rapidly now than
at any time in its existence. Every physician
in Mississippi should avail himself of the op-
portuntiy of attending this meeting at least
one day. Every elected delegate and alternate
should be present for the important meetings
of the House of Delegates. “United we stand,
divided we fall”. Organized medicine has stood
the test of time, and we are now at the cross-
roads from which we must go forward. De-
cisions should be made after careful delibera-
tion by the members of the profession chosen
to represent the profession at large, and there-
fore each officer, past-president, and delegate
should be present to take part in the discus-
sions in the House of Delegates.
The doctors of the Central Medical Society
tell us that they are more than ready and
willing to do any and everything to aid in
making the first annual meeting of the Mis-
sissippi State Medical Association since the
war, a success. Every doctor in Mississippi is
urged to attend this meeting and to call on
any member of the host society for aid and
assistance while in Jackson on May 14 and
15 at the Robert E. Lee Hotel, the convention
headquarters. L. W. L.
April, 1946
News and Comment
619
News and Comment
MESSAGE FROM OUR PRESIDENT
Dr. Crawford
The recent session of the Mississippi legis-
lature will go down in history as one of the
most progressive in the history of the state.
The hospital bill passed by the legislature
has made it possible for every community in
the state to have a hospital in reach. Without
hospital facilities there can be no satisfactory
solution of the medical man’s problem. The
old country doctor will soon pass off the stage
of action and become merely a pleasant
memory. The highly educated young doctor
who has served two years internship in a well-
equipped hospital will not be willing to locate
in a community far removed from a hospital.
Our problem is more a shortage of hospitals
than a shortage of doctors. The hospital will
be an inducement for doctors to locate in the
town or county.
Mississippi has always been a leader with
suitable hospital facilities, and can have a
medical college as good as the best. The medi-
cal profession will be satisfied with nothing
less.
Another legislature constituted largely of
the same membership passed the per capita
bill, making it possible for the local hospital
to take care of the indigent sick, permitting
the patient to remain under the supervision
of his family physician. '*
With the accomplishment of the plan made
into law by the legislature, the Mississippi
doctors can elevate their chins and take pride
in the fact that our state is again leading the
way, in providing satisfactory hospital and
medical service for practically everyone.
Let every doctor in Mississippi put his shoul-
der to the wheel and make this dream come
true.
SPEAKER OF THE HOUSE
Dr. Williams
Dr. J. Rice Williams of Houston, Miss., is
speaker of the House of Delegates of the Mis-
sissippi State Medical Association.
Dr. Williams is also president of the North-
east Mississippi Thirteen Counties Medical
Society, and a member of the Half Century
Club, which means that he has been practic-
ing medicine for more than fifty years.
Dr. Williams typefies in a fine way the
medical integrity of the profession. As
speaker of the House of Delegates of our
State Medical Association he has served ex-
ceedingly well. He knows parliamentary
rules and he is a diplomat of the first order.
In masonic circles Dr. Williams stands at the
very top. His work in this line has been
monumental. Mental honesty is an outstand-
620
News and Comment
April, 1946
ing trait of his character. His mind follows
the truth as certainly as water seeks its level.
His medical wisdom and his advice in the af-
fairs of man have served his state in a telling
manner.
He has not only practiced medicine for fifty
years, but he has kept informed and marched
in the front ranks as this great science won
its conquests for the good of mankind.
Dr. Williams loves his church and his lodge
and his medical confreres, his home and his
town and his state, but the very tenderest and
kindest love in his heart is that for our North-
east Mississippi Thirteen Counties Medical So-
ciety which he now serves as president.
Every member of this society esteems him as
a doctor and loves him as a friend. He will
preside at the next meeting of the society at
Booneville in June.
INVITATION
Two years ago we invited all the doctors
in the state who had been practising fifty
years to attend a luncheon at our state meet-
ing in Jackson. Last year we did not have
a regular meeting of the Association. The
idea of this meeting and the permanent or-
ganization that we are trying to perfect came
from Dr. W. A. Evans of Aberdeen, who be-
longs to a similar organization in Illinois. At
the coming meeting in Jackson, which opens
Tuesday, May 14, we are extending a cordial
invitation to every doctor in the state who
has been practising for fifty years, to be our
guest at a dinner on Tuesday at five-thirty
at the Robert E. Lee Hotel.
If you plan to be present, please drop us
a card as soon as you can.
Sincerely,
W. H. Anderson, M.D. Editor the
Mississippi Doctor
Booneville, Mississippi
LIST OF COMMERCIAL EXHIBITORS
FOR 1946
D. W. Jones, Jackson, Chairman of Exhibits
E. R. Squibb and Sons, New York.
Southern Surgical Supply Co., New Orleans.
Van Pelt and Brown, Richmond.
Mead- Johnson and Company, Evansville,
Ind.
American Surgical Supply Company, Jack-
son, Miss.
A. S. Aloe Company, St. Louis.
Lederle Laboratories, New York.
E. J. Hart Company, New Orleans.
J. B. Lippincott Company, Philadelphia.
E. L. Mercere, Inc., Memphis.
General Electric X-Ray Company, Memphis.
The Borden Company, New York.
Kay (Surgical, Inc., Memphis.
Dick X-Ray Company, Memphis.
The White Laboratories, Newark.
McKesson and Robbins, Birmingham.
J. A. Majors Company, New Orleans.
PHYSICIANS RETURNED FROM MILITARY
SERVICE
One hundred fifty-eight physicians have re-
turned to Mississippi from military service.
Seventy or 44 per cent located in towns of
less than 5,000 population.
Twenty-two or 14 per cent located in towns
of less than 10,000 population.
Nineteen or 12 per cent located in cities
of less than 20,000 population.
Twenty-five or 16 per cent located in cities
of less than 50,000 population.
Twenty-two or 14 per cent located in cities
with 50,000 population or more.
One hundred seventeen, or 74 per cent, re-
turned to former practice.
Twenty-nine, or 18 per cent, located in dif-
ferent town.
Five or 3 per cent, were not previously lo-
cated.
Seven or 5 per cent, previously out-of-state
located in Mississippi.
REFRESHER COURSE IN
OTOLARYNGOLOGY
A one week didactic and clinical refresher
course in otolaryngology has been arranged for
specialists in the field, from May 13 to 18,
1946, inclusive. Applications for registration
should include school of graduation, training
and experience. Check for tuition ($50.00)
should accompany the application.
In addition, a special course in broncho-
esophagology will be given from June 3 to
15, 1946, inclusive. It will consist of lectures,
animal and cadaver demonstrations, diagnostic
and surgical clinics.
The course will be under the direction of
Drs. Paul H. Holinger and Albert H. Andrews,
Jr.
April, 1946
News and Comment
621
Tuition for this course is $100.00. Check
should accompany application. Class limited
to twelve physicians.
For further information address :
Department of Otolaryngology, University
of Illinois College of Medicine, 1853 West
Polk Street, Chicago, Illinois.
DESOTO COUNTY
The affairs of the Second Councilor District
are in a good order. The North Mississippi
Medical Society voted to unite with the North-
east Thirteen Counties Society. The Tate and
Desoto county societies have one hundred
per cent membership.
The North Mississippi Hospital had an aus-
picious opening, with Dr. V. B. Philpot in
charge.
We will be pleased to see you all in Jack-
son at the state meeting, May 14.
STATE MEDICAL EXAMINATION NOTICE
The Mississippi State Board of Health will
hold medical examinations on June 17 and
18, 1946 in Jackson, Mississippi. (Convention
Hall, Mezzanine Floor, Edwards Hotel).
Examinations may be taken on the first
two years only (June 17), as well as on all
four years of medicine; (or on the last two
years (June 18) for those who have passed
the first two years before this Board).
For application blank and other information
write to: Dr. R. N. Whitfield, Assistant Sec-
retary, State Board of Health, Jackson 113,
Mississippi.
TO A SPEEDER*
I saw you barely miss a little boy on a
tricycle this afternoon, and heard you yell,
“Get the hell out of the way. Don’t you know
any better than to ride in the street?” He
didn’t answer because he hasn’t learned to
talk yet. So I’m going to answer for him.
No, the little boy doesn’t know any better
than to ride his tricycle in the street. He
has been warned not to, but little boys don’t
always heed warnings. Some adults don’t, es-
pecially traffic warnings; for example, the one
limiting the speed of automobiles in city
streets.
I am going to tell you something about that
little boy: He has a mother who endured
considerable inconvenience, anxiety and suf-
fering to bring him into the world. He has
a father who worked hard and made many
sacrifices to make him healthy nad happy.
The supreme purpose of their lives is to
have their little boy grow up to be a useful
and prosperous man.
Now stop a minute and think. I know your
minutes are valuable and I know it will be
hard for you to think. But try. If you should
kill a child, how would you feel facing its
parents? What excuse could you possibly offer
Him whose kingdom is made up of little chil-
dren?
Children, my friend, were here before you
or your automobile were ever thought of. All
the automobiles on earth are not worth the
life of one little boy on a tricycle. Any com-
petent gfarage mechanic can put a car to-
gether, however badly it’s smashed, but no-
body on earth can put a child together once
its life has been crushed out. We don’t know
what that child may some day be. But we
know what you are, and it’s unimportant. We
could get along without you, but we can’t
spare a single little boy on this street.
My friends, be careful and do not let this
happen to you.
*New Orleans physician has written for this
story, so I take this method of getting it to him
and many others who would do well to read and
profit thereby. It is from the Augusta Union. (L.
L- Minor)
ARTEMIS WARD SAID IT
Let us all be happy and live within our means,
even if we have to borrow the money to do
it with.
Chronic irritation is thought to play a big
part in causing cancer.
Deaths
DR. JOSEPH B- STONE
Services for Dr. Joseph Boon Stone, who distin-
guished himself in Mississippi education and politics
and practiced medicine in Memphis from 1921 un-
til his death, were held March 10 in Memphis.
Dr. Stone maintained his practice, although not
so actively in recent years, until he suffered a
stroke.
The doctor was born at Como, Mississippi. His
father, the late Rev. Sam Stone, lived much of
his life in Arkansas and once was president of
Searcy College. Dr. Stone was graduated there and
received his medical degree at Vanderbilt University.
622
Book Reviews
April, 1946
He did postgraduate work at New York University.
He practiced in Quitman County, was owner of
Lost Lake Plantation at Belen, Miss., superintendent
of Quitman County schools and a representative of
the county in xhe Mississippi State Legislature.
He served in the Medical Corps in World War
I in Siberia, China, the Philippines and France,
and left service as a lieutenant colonel.
He leaves a son, Coe Stone of Memphis, and a
daughter, Mrs. Joe Taylor of San Antonio, Texas.
DR. JOHN G. PRINE
Burial of Dr. John G. Prine, seventy-seven years
old and a former member of the house of represen-
tatives in Mississippi, on March 27 closed the life
chapter of a typical “country doctor.’’
Doctor Prine, born in the former Lenoir com-
munity now known as Morgantown, Marion County,
worked as a day laborer and at the age of twenty-
three began going back to school to become a doc-
tor- He obtained his M.D. degree from the University
of Tennessee, passed the state board of examiners
and returned to his native rural community on
Pearl River where he spent the remainder of his
life practicing medicine among his folk.
During the depression years, the people were un-
able to pay their medical bills- Doctor Prine got
a job as rural mail carrier, served his postal route
in day and served his patients during off hours.
He was later elected to the Mississippi house as
representative from Marion County to succeed Kelly
J. Hammond, of Morgantown. Hammond, attorney,
now with the Veterans Administration in Jackson,
delivered a eulogy at the doctor’s funeral. Religious
rites were conducted by the doctor’s Baptist pas-
tor, the Reverend Chappel.
Survivors are: three sisters, Mrs. J. W. Weather-
ford of Picayune, Mrs. Jessie Headspeth of Goss
and Mrs. Alice L- McCall of Brookhaven; and three
brothers, Charles Prine, T. M. Prine of Goss and
Dr. J- S. Prine of Columbia.
DR. TOM W. MERIWETHER
Death came suddenly on November 24 from
spinal meningitis to Capt. Tom W. Meriwether of
Doddsville, Mississippi. Serving with the Medical
Corps in Seoul, Korea, he was scheduled to leave
December 15 to be home and discharged by Christ-
mas. - ' r -An.f
He was well the day before his death, according
to a letter dated November 23 received by Mrs.
Meriwether. The family did not know of his illness
until the telegram arrived.
Born in Memphis, the thirty-two-year-old physican
was educated at the old Memphis University School
and attended the University of Tennessee before
taking medical work at U. T. School of Medicine.
He received his degree in 1933 and practiced in
Senatobia, Mississippi, before going to Doddsville.
He planned to resume his practice there upon his
return.
Going overseas last January, Captain Meriwether
was in three major battles on Okinawa and was
caught on the China Sea during the Pacific ty-
phoon, en route to his post in Korea.
He was the son of the late T. W. Meriwether, who
was associated with the Illinois Central Railroad.
The captain leaves, besides his mother and wife,
a son, Tommy Meriwether III, 10, and a daughter;
Val Meriwether, 12. » \
Book Reviews
Geriatrics is steadily gaining in medical
cognizance. But it is a field that still lacks
the consideration due it. This subject is much
more important than it was a half century
ago because many more people are reaching
the number of years that class them as aged.
In this country we must give much credit
to Dr. Malford W. Thewlis of New York City.
His fifth edition of Geriatrics, revised with
sixty-five illustrations is composed of 500
pages and is written in a most interesting
manner.
This book is very valuable to every man in
the practice of medicine whether he be a
surgeon, in general practice, public health,
or even a pediatrician. It deals with the prac-
tical clinical problems of the aged, observed
over a period of thirty-four years of clinical
work. The author points out that the cause
of aging is not yet known just as the cause
of cancer is not, but there can be some things
done about senescence. During the war the
treatment of the aged has assumed greater
importance as the older men and women have
been called to take the place of the younger.
To keep the aged mentally and physically fit
will be very important in peace time, as point-
ed out by the author. This book contains con-
tributions from six authors and, in addition,
contributions from many friends. It is divided
into eight parts : General Considerations,
Geratology, Medico-legal, Miscellaneous Prob-
lems, Diseases of Metabolism, Infections, Sys-
temic Pathologic Conditions, and Special
Topics.
Some of the very interesting topics stressed
are: prevention of coronary thrombosis in
physicians, home treatment of pneumonia, gas-
tritis, mental hygiene, and preventing the aging
processes.
The book is so well written that it is more
like reading a novel than a book on a scientific
medical subject of the greatest importance.
Order your copy from C. V. Mosby, St. Louis.
Spring with its beautiful flowers and gras-
ses is here again. Nature is loveliest in the
spring-time.
Capricious April with its whimsical weather
conditions brings meetings, Mississippi Medi-
cal particularly.
Medical Literature
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — W. H. Parsons, Vicksburg.
r
Urology — Temple Ainsworth, Jackson.
PATHOLOGY,
Diverticula (Luschka/s Crypts) of the
Gallbladder. H. E. Robertson, M.D., and Wil-
H. E. Robertson, M. D., and Wilson J.
son J. Ferguson, M.D., Rochester, Minn. Ar-
chives of Pathology. Vol. 40:312-333, Novem-
ber-December, 1945.
Following an exhaustive review of the litera-
ture, the authors attempt to clarify the ana-
tomic and pathologic significance of our pouch-
ings of the mucosa of the gallbladder; and
present their findings in the histological exami-
nation of 495 gallbladders obtained from two
sources— necropsies (175) and surgical opera-
tions (320).
Their conclusions are as follows: “In ap-
proximately half of all gallbladders removed
from persons more than thirty years of age
the mucosa has invaginated the underlying
structures, sometimes as far as the peritoneal
lining.”
“This invagination tends to form diverti-
cular spaces with branching pouches, which
occasionally simulate mucous glands. They are
lined with epithelium corresponding in every
respect to that which lines the mucosa of -the
inner surface of the gallbladder. These cells
secrete mucus or a mucus-like fluid.”
“The greater number of the diverticulae open
into the lumen of the gallbladder by ducts,
v/hich are often tortuous and narrow. Some
are cut off in whole or in part from the
lumen and become cysts with budlike branches.
When such a group is more or less localized,
a formation, often called an adenoma, is pro-
duced. It is most frequently found in the fun-
dus of the gallbladder but may occasionally
involve more, or even all, of the gallbladder.
The term ‘adenoma’ is misleading and inaptly
applied. ‘Multicystic diverticula’ and ‘multi-
locular cystic diverticula’ are more fitting
designations.”
“The crypts thus formed may contain bile,
bile pigments, cholesterol crystals or at times
typical biliary calculi. Exudative inflamma-
tion may occur in them up to the stage of ab-
scess formation and even of rupture into the
peritoneal cavity. The residuum of such in-
flammation may be obliteration of the epithe-
lial lining, proliferation connective tissue and
collections of lymphocytes and otherEjcelIs.”
“Increased intracystic pressure, absence of
muscularis mucosae, a loosely, irregular ar-
ranged muscular layer and the independent
response of the muscle bundles to physiologic
stimuli account for the initial diverticula-like
indentations. The increased pressure is, more
logically, the result of neurogenic dysfunction-
al states of the extra-hepatic biliary system,
although other mechanical factors, such as
stones and inflammatory obstructions, may
play etiologic roles.”
“Except for the complexity of the branches,
these crypts correspond in every respect to
the so-called false diverticula of the colon and
the urinary bladder and should be denominated
diverticula of the gallbladder.”
“There is little except custom to justify
calling them Luschka’s crypts of Rokitan-
sky-Ascholl sinuses. Not only did these in-
vestigators not possess sufficient priority but
they failed in several important details to re-
cognize the true significance of the structures
which they described.”
PEDIATRICS
Poliomyelitis — Louis P. Gebhardt, Ph.
D., M.D. and William M. McCay, M.D., CHP..
Salt Lake City, Utah — The Journal of Pedia-
trics— January, 1946.
The authors’ introductory in this article
states that the disease poliomyelitis is endemic
in many parts of the United States through-
624
Interpreting Medical Literature
April, 1946
out the year, but epidemic periods usually are
evident by June or July, the peak being in
August or September with a beginning decline
by October. In the warmer climates of the
United States, the disease may show an up-
ward swing as early as April, as v/as the case
in the Los Angeles area during the 1943 epi-
demic. This general cycle of endemicity and
epidemic peaks is repeated regularly with
moderate to severe epidemics being prevalent
every four to six years, with a general region-
al variation in the United States.
The authors in this paper point other means
than contact as the mode of spread of this
disease. Twelve multiple cases of poliomyelitis
developed in six families on the same day;
twenty multiple cases developed from one to
five days after onset of the disease in a bro-
ther or sister and ten of these cases de-
veloped within two days of that of the siblings.
Of a total of forty-five multiple cases in fami-
lies, thirty- two developed in less than the
generally accepted incubation period of from
seven to fourteen days after exposure, if we
consider the brother or sister to expose an-
other member of the family. In one family
with four cases, two children developed the
disease the same day and two developed the
disease two days after. Two other children,
who had played with those in the family with
four multiple cases and had oaten of the same
unwashed peaches, apples, and pears on Au-
gust 17 and 18, 1943, developed the disease
August 31 and September 1, respectively, or
about the same time that the multiple cases
of the disease (four in one family) had de-
veloped. This data therefore suggests that the
majority of these patients were exposed to the
virus at about the same time and probably
from the same source. No direct contacts with
any known cases of poliomyelitis and the mul-
tiple cases could be traced, except the family
unit and the two cited cases of patients who
developed the disease at the same time as the
four children in the other family.
This is in contrast with multiple cases in
families having a well-known contact disease
such as measles, mumps, or chicken-pox, where
a brother or sister generally develops the dis-
ease after the regular incubation period, when
secondary cases in families develop.
Possible common virus sources for these
multiple cases of poliomyelitis in families
could be virus contaminated foodstuff, since
all members of a given family unit usually eat
the same kind of food.
Peak fruit and vegetable production and
highest fly incidence correlate the peak period
of poliomyelitis cases and the evidence pre-
sented that 100 per cent of the persons in the
cases surveyed had eaten unwashed or un-
peeled fresh fruits and vegetables from one
to two weeks prior to developing poliomyelitis,
suggests that food may play a role in the
dissemination of the virus. Ample virus source
could well be represented in area of faulty
sewage disposal and with swarms of flies pres-
ent, virus to-fly-to food-to-patient seems to be
in the realm of probability. Such foods that
may be contaminated with the virus find their
way into many different areas, including re-
mote and isolated places, which would ac-
count for isolated and sporadic cases of the
disease.
It is suggested, therefore, that poliomyelitis
is an accidental disease of the “filth borne”
group of diseases; that “virus contaminated
food” may play a very active role in the
spread of this disease. The limitations of
spread of the virus would be dependent on fly
population, source of virus for flies, and an
adequate source of fresh foods, such as
fruits and vegetables, as well as other foods
that may be eaten uncooked. Also that such
foods be convenient to populated areas in
order for virus, that may be deposited, to
survive for a sufficiently long enough time
to be ingested by susceptible individuals.
Definite proof of the spread of virus of
poliomyelitis by means of contaminated food
rests on actually isolating the virus from
fresh foodstuffs and demonstrating that flies
may contaminate such foods by depositing
virus thereon. Such proof has been suggested
by Ward and associates since they were able
to isolate the virus from bananas contami-
nated by flies.
A summary of this article is as follows:
1. Multiple cases of poliomyelitis in families
show that the majority of the cases developed
at the same time. Also that in these multiple
cases the children probably Obtained the virus
at the same time and from the same source,
suggesting means other than contact as the
mode of spread.
2. Fresh unwashed or unpeeled fruits and
vegetables were eaten in 206 of the 206 cases
of poliomyelitis surveyed.
3. Direct contact was traced in only 13.6
April, 1946
State! :Board of Health
625 ,
per cent of the 241 cases surveyed.
4. No evidence was found that water sup-
plies, milk supplies, or swimming pools were
means fey which the disease was disseminated.
5. Bite of insects, such as flies and mos-
quitoes, suggests a possible means of virus
spread.
6. Closing of schools during the epidemic
failed to reduce the incidence of the disease
among the school age group.
COMMENT
This article is quite interesting since it has
a tendency to show that poliomyelitis is ob-
tained in ways other than -by contact. There
have been quite a few investigations, the re-
sults -of which have convinced, the investiga-
tors -that polio is obtained through the con-
sumption of fresh unwashed or unpeeled fruits
and vegetables, and this is just another one
of the investigations which seems to be rather
convincing. At least it should behoove all of
us who have the care of children under our
supervision to teach those responsible the ne-
cessity of washing and peeling fruits and
vegetables that are to be consumed without
cooking..
State Board of Health
Felix J- Underwood, M .D.
THE STAGE IS SET
By A. L. Gray, M.D., Director
Division of Preventable Disease Control
As physicians and public health workers
begin to turn from wartime to peacetime ac-
tivity, there is a mingled feeling of relief and
of looking-forward. Relief, because there can
be some letting up on many of the wearying
demands of war; a looking-forward because
there will be a little more time to put into
effect some of the far-reaching advances of
the past few years and to achieve more of
the constructive ends of present-day medical
knowledge.
Even though the shooting and bombing war
is over, there is little question but that we
are far from victorious in the war against
disease, although we have admittedly made
some good progress. Consider the present in-
cidence of diseases like diphtheria, tubercu-
losis, typhus fever, poliomyelitis, cancer, un-
dulant fever, influenza, meningitis syphilis,
gonorrhea, hookworm disease and numerous
others. These diseases have prevailed among
the people of the state and nation for many
years, although many of them had declined
in prevalence until the beginning of the war.
Are we now to witness the same alarming in-
crease in disease incidence as has always fol-
lowed previous wars? Some authorities have
expected such increase, limited in extent only
by the degree of intelligent application of
known measures of control. There is already
some evidence of increased prevalence of cer-
tain diseases.
what are the reasons for this increased
danger following war? First, most of these
diseases thrive in the midst of a moving and
crowded population. About twenty-seven mil-
lion people migrated from their home com-
munities to do war work. An additional ten
million men are being demobilized. Nearly
one-third of the population will be going back
home. They will be coming back from many
areas of the world and to their home com-
munities they are likely to bring certain of
the diseases prevalent to the countries from
which they come or diseases contracted en
route to their homes. A new vigilance is
called for in preventing spread of these dis-
eases.
Amother situation favorable to increase is
the critical housing shortage — a situation
which it may not be possible to correct for
several years. The more crowded people live,
the greater ease with which diseases spread.
The practice of good personal hygiene and
sanitation becomes more difficult, both of
which are all important in keeping down the
spread of infection.
This is not the whole story by any means
as to why communicable diseases may in-
crease. Public health departments which
626
State Board of Health
April, 1946
form the bulwark against these diseases are
at least 25 per cent understaffed and much
time will be required to reconstruct health
staffs to levels of safety. Then there is the
shortage of physicians in Mississippi, with no
early relief in sight, and this is bound to have
a profound influence on keeping diseases in
check.
Let’s look at a few of the problems more
specifically. In the first place, diphtheria has
not only increased to serious proportions in
Europe, but also in Mississippi in the last few
months. This increase in diphtheria is result-
ing from (1) fewer children receiving diph-
theria toxoid (physicians and health officers
have not been able to devote as much as usual
to this phase of control); (2) moving and
crowding of population; (3) cyclic ocurrence
of the disease. Undoubtedly much more must
be devoted to control. Parents must be alerted
to the dangers of neglect and urged to seek
preventive measures for their children at the
proper time.
Another disease which takes an unneces-
sary heavy toll each year is tuberculosis. Over
55,000 Mississippians have died of this dis-
ease since 1913, and it is estimated that there
are 5,000 known cases in the State at the pres-
ent time. Ignorance and apathy are respon-
sible for many deaths each year. Much can
be done to alleviate this situation when pres-
ent knowledge regarding the disease is fully
applied. There is new hope for better com-
batting tuberculosis through the intensive
case-finding program now being initiated
throughout Mississippi and other states in co-
operation with the United States Public
Health Service. Plans have been developed
which will make it possible to x-ray chests of
all people in a given county within a few weeks.
Miniature x-ray pictures costing only a few
cents per person will be used. It is hoped to
be able to x-ray the entire population of the
State within five years. This method of ap-
proach will find many cases of tuberculosis
in the early stages when cure can be effected
and measures instituted to check the spread of
the disease. We can and we must prevent
the usual postwar increase of tuberculosis as
well as eradicate it.
The two diseases, syphilis and gonorrhea,
which received so much attention during the
war will continue to require vigilance. As
Dr. Thomas Parran, Surgeon General of the
United States Public Health /Service, points
out, “The potentialities of their increased
transmission and entrenchment in new strong-
holds are great, because public health au-
thorities will have to work uphill against an
enormous and unrestricted movement of pop-
ulation, against depleted services, and against
Relaxed public opinion.” With newly ac-
quired knowledge of rapid treatment, case
finding, and education during the war, and
with a continuation and intensification of the
present program, these diseases should be prac-
tically eradicated within the next ten years.
But if the line is not held, a rapid and con-
tinued increase for several years may be ex-
pected, weakening the structure of the com-
munity and bringing untold suffering and han-
dicap to people in all walks of life. It is up
to physicians and health officers to see that
this line is held and that citizens generally
appreciate the necessity for fullest cooper-
ation in controlling these diseases.
Typhus fever has been increasing in preva-
lence in the State for a number of years and
considering its amazing record in winning the
wars which “generals start,” it should be at-
tacked with every weapon at our disposal.
Foremost among preventive measures is a rat
eradication program in which individuals and
communities will be called upon to cooperate.
Undulant fever also calls for community ac-
tion, as it undoubtedly will continue to in-
crease in proportion to the consumption of
raw milk from cows infected with Bang’s dis-
ease. Prevention consists of pasteurization of
milk and elimination of infected cattle from
the herds. Another factor which enters into
the spread of this disease is the public auc-
tion where many cattle known by the owners
to be infected are purchased by unsuspecting
individuals.
Cancer, one of the most feared diseases, is
being attacked with new vigor and interest
in the state. In the light of present scien-
tific knowledge of cancer, the annual loss of
approximately 1500 of our citizens from this
disease is an indictment of the public con-
science, the medical profession, and public
health workers. A large percentage of these
lives can be saved through proper cooperation
of the public, the physicians and public health
workers. The Mississippi Division of the
American Cancer Society has made a good
start toward solving this problem. It remains
for the medical and public health professions
and the general public to get behind this pro-
State Board of Health
627
April, 1946
gram and give it fullest support to help bring
about a decrease in the number of cancer
deaths. Indications are that they will as is
evidenced by the increasing and support of
recent months.
A most serious deficiency in communicable
disease control is the almost complete lack of
hospitalization facilities for such diseases as
meningitis, typhoid fever, scartet- fever*_ diph-
theria, etc. Practically all public and pri-
vate hospitals in the State will not knowingly
admit communicable diseases for treatment.
Other states are far out in front of Missis-
sippi in this regard and admit communicable
disease cases for treatment, having instituted
the proper *procedures for preventing cross-
infection. As long as such procedures are
adhered to carefully, there is little likelihood
of jeopardizing the. health of the other pa-
tients. Mississippi does have one good hos-
pital which has had the foresight to meet this
situation. It is hoped that others will fol-
low the example it has set, for as long as
there is failure to hospitalizes communicable
disease cases, there is less chance for re-
covery for the patients and increased danger
of spreading the infections in the community.
Protection against all such diseases can and
should be secured. The stage is set for a new
era in health advances demanding an arm-in-
arm march of physicians, public health work-
ers, hospitals, and individuals — an enlighten-
ed army marching against the enemies of life
and health promising a fuller measure of real
living for all participants.
STATISTICS
The Division of Vital Statistics reports
that there were 315 more deaths in Missis-
sippi during December, 1945, than in Novem-
ber, 1945 — an increase of 23 per cent. Some
of the increase was expected for December
due to the large number of deaths which usu-
ally occur during this month as a result of
respiratory infections. There were 74 deaths
from influenza and 79 deaths from broncho-
pneumonia and lobar pneumonia. Other se-
lected causes of death in December were re-
ported as follows:
Diphtheria 4
Pulmonary tuberculosis 37
Syphilis 25
Cancer 124
Diabetes 26
Pellagra 4
Pneumonia T 79
Maternal deaths 14
Congenital malformations 9
Premature birth 34
Violent or accidental death 187
Automobile accidents 43
Ill-defined or known causes 253
PHYSICIANS RETURNED FROM
MILITARY SERVICE
158 physicians have returned to Mississippi
from military service. 70, or 44 per cent, lo-
cated in towns of less than 5,000 population.
22, or 14 per cent, located in towns of less
than 10,000 population. 19, or 12 per cent,
located in cities of less than 20,000 popula-
tion. 25, or 16 per cent, located in cities of
less than 50,000 population. 22, or 14 per
cent, located in cities with 50,000 population
or more. 117, or 74 per cent, returned to pre-
vious locations. 29, or 18 per cent, located
in different towns. 5, or 3 per cent, were not
previously located. 7, or 5 per cent, previous-
ly out-of-state, located in Mississippi.
PREVALENCE OF COMMUNICABLE DISEASES
IN MISSISSIPPI
February
February
February
1946
1945
Five-Year
Average
Acute Poliomyelitis
6
3
3-4
Bacillary Dysentery
574
618
478.0
Dengue
0
0
0.0
Diphtheria
32
37
26.8
Influenza
14227
8942
10504.0
Measles
2738
1952
2655.4
Meningococcus Meningitis 16
17
26.8
Other Forms Meningitis
6
6
9-2
Pellagra
138
160
158.0
Pneumonia
2839
2564
2518.4
Pulmonary Tuberculosis
100
109
110-8
Scarlet Fever
36
189
75-8
Smallpox
1
1
2.0
Tularemia
6
1
4.6
Typhoid Fever
3
7
7.2
Typhus Fever
19
8
6.0
Undulant Fever
1
4
2.8
Whooping Cough
476
717
822.8
Due to improved methods of case-finding
and more widespread knowledge about the
disease, tuberculosis did not increase in this
country during the war, though it rose to
alarming proportions in Europe and Asia.
Nevertheless, it is deplorable that tuberculosis
took more than 205,000 American lives during
the war years. — Harry S. Truman.
628
k Woman’s Auxiliary
Womans /Auxiliary
President . . . Mrs- L: J. Clark
Vicksburg
President-Elect ...... ...... Mrs. Stanley Hill
Corinth
First Vice-President ... Mrs. H. C. Ricks
Jackson
Second Vice-President Mrs. Henry Boswell
Sanatorium
Third Vice-President Mrs. W. H. Anderson
Booneville
Recording Secretary Mrs. Geo. W. Owens
Jackson
Fourth Vice-President Mrs. Ben Walker
Jackson
Treasurer Mrs. J. D. Simmons
Cleveland
Historian Mrs. Harvey Garrison
Jackson
FROM OUR PRESIDENT
Dear Auxiliary Members:
This is my last message to you before our
state meeting in May.
My associations have been most pleasant,
and it is with some feeling of regret that I
give up the office as president. It is with
pleasure though that I pass the responsibility
on to one as capable and gracious as your
president-elect, Mrs. Stanley Hill. For two
years she has worked diligently in her office,
and is far more familiar and experienced
in the work than I.
Let me urge you to attend our state con-
vention in Jackson, May 14-15. Since we had
no meeting last year there should be a great-
er eagerness than ever to attend this one.
We missed the inspiration that we gain from
the friendly contacts and renewed friendships.
I shall be happy to see every familiar face,
and eager to meet and know the many new
members. I rejoice with those of you whose
husbands have returned from service, and
you will have a more cordial welcome than
ever at our reunion.
If you are not an Auxiliary member, please
become one immediately. There is a greater
need than ever for organization of our doc-
tors’ wives.
Women’s influence in legislation is important
and we are more interested now than at any
other time. We have had a part in some con-
structive legislation in our state — The pre-
marital examination law, the four-year medi-
April, 1946
cal school, and the defeat of the Wagner-
Murray-Dingell bill are legislative measures
that we are interested in. We need a good,
strong, well-informed auxiliary, to study and
interpret the many changes taking place.
My two years as your president have been
a privilege. It is my hope that the Auxiliary
will continue to grow in strength and useful-
ness. Whatever progress has been made dur-
ing my two terms as president has been be-
cause of your — officers, councilors, and mem-
bers, your cooperation, encouragement, and
helpfulness in every way.
My heart is full of love and deep apprecia-
tion for your every consideration of me.
Affectionately, *
Anne Clark
STATE PRESIDENT HONOR GUEST AT
LUNCHEON
The Jackson County unit of the Auxiliary
to the Coast Counties Medical Society was
hostess to doctor’s wives of the Ninth Dis-
trict of the State Auxiliary at a luncheon in
the home of Dr. and Mrs. R. C. Eley in Moss
Point on Friday, March 8.
The luncheon was arranged buffet style
from a spring dining table centered with a
beautiful arrangement of cut flowers. Guests
served themselves to a delicious menu of tur-
key and all the accessories, then found their
places at card tables which had been arrang-
ed in the double parlors. Mrs. Eley’s daughter,
Mrs. W. F. McLeod, assisted her in serving
coffee and a dessert course of ice cream and
homemade cake. Azaleas and other spring
flowers were used in profusion throughout
the spacious reception suite.
After the luncheon Mrs. S. B. Mcllwain,
president of the Jackson County Unit and
councilor for the Ninth District, welcomed
the visitors and introduced Mrs. L. J. Clark
of Vicksburg, president of the State Auxiliary.
Mrs. Clark spoke of many topics concerning
Auxiliary work, and emphasized pending legis-
lation that vitally concerns the medical pro-
fession and the public as a whole.
Those present: Mrs. E. C. Parker, Gulfport;
Mrs. J. J. Carter, Mrs. Presley Werlein, Mrs.
D. L. Hollis, Mrs. Harold, Mrs. B. J. Welch of
Biloxi; and Mrs. F. O. Schmidt of Ocean
Springs.
• .'he A. I «
April, *946 Woman’s
Co-hostesses with Mrs. Eley were Mrs. L.
H. Eubanks, Mrs. W. J. Weatherford, Mrs.
Robert Cameron, Mrs. J. N. Lockhard, Mrs.
Andrew Hedmeg, and Mrs. S. B. Mcllwain of
Pascagoula, and Mrs. J. T. Thompson of Moss
Point.
DOCTORS ENTERTAINED BY CENTRAL
MEDICAL AUXILIARY
Husbands of the members of the Central
Medical Auxiliary were delightfully entertained
with the annual Doctors’ Day party which was
in the form of a picnic supper at Battlefield
Park.
Outdoor games and a social hour were
enjoyed until 6:30 o’clock, when a delicious
supper was served picnic style under the direc-
tion of the committee composed of Mrs. A. G.
Wilde, Mrs. J. Gordon Dees, Mrs. W. F. Hand,
Mrs. T. E. Wilson, Mrs. V. D. Hagaman, Mrs.
Boyd Edwards and Mrs. Walter Lipscomb.
Following supper, the company gathered in
the recreation building where Mrs. Peter J.
Trolio, assisted by Mrs. Marvin E. Dobson at
the piano, graciously directed the entertain-
ment for the occasion. The guests participated
in and greatly enjoyed a grand march, square
dancing, group singing and a quiz program.
Those present included: Dr. and Mrs. G. E.
Riley, Dr. and Mrs. A. G. Wilde, Dr. and Mrs.
W. F. Hand, Dr. and Mrs. J. Gordon Dees,
Dr. and Mrs. H. C. Ricks, Dr. and Mrs. Guy
Post, Dr. and Mrs. J. P. Wall, Dr. and Mrs.
P. R. Greaves, Dr. and Mrs. Galahey, Dr.
and Mrs. Fred Hollowell, Dr. and Mrs. T. G.
Ross.
Dr. and Mrs. Sterling McNair, Dr. and Mrs.
Robert Price, Dr. and Mrs. Temple Ainsworth,
Dr. and Mrs. Reddens, Dr. and Mrs. W. R.
Bethea, Dr. and Mrs. W. E. Noblin, Dr. and
Mrs. C. C. Smith, Dr. and Mrs. W. J. Witt,
Dr and Mrs. Buren Alexander, Dr. and Mrs.
Steve Coley, Dr. and Mrs. J. P. Rude, Dr.
and Mrs. R. C. O’Ferrall, Dr. and Mrs. H.
F. Garrison, Sr., Dr. and Mrs. J. G. Thomp-
son
Dr. and Mrs. L. W. Long, Mrs. Ellis, Mrs.
Nathan Kendall, Dr. and Mrs. A. E. Gordon,
Dr. John McIntosh, Dr. and Mrs. T. S. Robert-
son, Dr. and Mrs. H. C. Sheffield, Dr. and
R. F. Grenfell, Dr. and Mrs. Charles Ward,
Dr. and Mrs. J. W. Wadlington, Dr. and Mrs.
W. A. Smithson, Mrs. A. L. Gray, Dr. Dill-
worth, Dr. W. C. Redmond, Dr. and Mrs. H.
Auxiliary 629
' J
F. Magee, Dr. and Mrs. Boyd Edwards, Dr.
and Mrs. Bill Austin, Dr. and Mrs. J. Walton
Lipscomb, Dr. and Mrs. T. E. Wilson
Dr. and Mrs. T. B. Holloman, Dr. and Mrs.
F. A. Donaldson, Dr. and Mrs. J. B. Marshall,
Dr. and Mrs. Ray Biggs, Dr. and Mrs. L.
R. Reed, Mr. and Mrs. Peter J. Trolio, Mr.
and Mrs. Marion V. Dobson.
The exact cause of cancer is not known. .
It kills more men than women. One hundred
and seventy-five thousand people will die of
cancer this year.
Deaths from cancer are on the increase,
one person in America dies of cancer every
three minutes.
Cancer is no respector of age.
The attack on cancer is to be made from
three fronts: education, service and research.
One person in eight will die of cancer un-
less there is something done about the matter.
Only heart disease takes a greater toll of
human life than cancer. Twelve million dollars
are to be contributed this year to fight cancer.
Successful treatment of cancer rests upon
accurate and prompt recognition of the type
and location of the cancer which is to be
treated.
The only certain way to make sure of can-
cer is by microscopic examination of the sus-
pected tissue by a trained specialist.
The history of quackery in cancer is a long
and evil one.
Surgery, x-rays and radium are the ap-
proved treatments, one or a combination.
Cancer is uncontrolled growth of one or
more cells.
The Mississippi Doctor
April, 194
by extra
When thyroid dosage is balanced
vitamin intake, there is little opportunity for the.
increased metabolic rate to cause a Vitamin de-
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Maintain the thyroid patient’s vitamin balance
prescribe thyroid plus vitamins — Warren-Tee£t>
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Each Warren-Teed VITAROID Tablet contains*
Thyroid
Vitamin A
'
Synthetic Oleovitamin D
(Activated Ergosterol)
Ascorbic Acid
Riboflavin
■
Thiamine Hydrochloride
S Nicotinamide
200 U.S.P. Units
15.0 mg.
1.0 mg.
G.5 mg.
5.0 mg.
Medicaments of Exacting Quality Since 1920
Warren-Teed Ethical Pharmaceuticals: capsules, elixirs, ointments,
sterilized solutions, syrups , tablets. Write for literature.
Medical Progress in the .Twentieth. Century
PRESIDENT’S ADDRESS —
B. LAMPTON CRAWFORD,
.-II. . .. ,
Tylertown, Miss.
-• i-v -C- . i
ustom of the Mississippi Medical Asso-
ciation enjoins upon the president the
‘duty and the privilege of the delivery of
an address at the annual meeting of the Asso-
ciation; a task that is a duty because an un-
1 written law imposes it, and a privilege because
it gives to one about to make his final of-
ficial appearance the opportunity of communi-
cating to his fellows any thoughts which he
may hold significant.
Had this message been delivered a year ago,
my subject would have been socialized medi-
cine. But an aroused medical profession and
the thinking public are finally realizing that
the greatest profession is in -danger of being
destroyed and the greatest democracy is
gradually being converted into a socialistic
government, and are therefore determined that
this shall not happen in liberty-loving Ameri-
ca.
It is very- fashionable at the time being to
maintain that the health of the American
people is in a deplorable condition, and one
would think, to listen to the proponents of
compulsory health insurance, that people are
dying like flies of untended illness. But it is
a fact that the medical service and hospital
attention in the United States are not excelled
by any nation. No country ever sent a health-
ier or finer armed force to war than did the
United States in the recent war. The mortality
rate of the wounded was the lowest ever re-
corded. as a result of efficient medical service.
The medical profession is one of the noblest
of human calling. It has been so regarded in
most countries throughout the centuries. Like
other fields of endeavor, medical science has
progressed very slowly until the present
century.
During the past half century, the increase
in scientific knowledge of the human body has
been marvelous, and the understanding of the
cause and cure of many diseases has made
tremendous strides.
There has never been a time when the
human race, the nations of the world, and
our profession in particular needed intelligent,
r-o/r< . o
careful, thoughtful com.mon sense leadership
more than it does today. Therein lies a chal-
lenge to all of us to bring forth the best, the
most substantial traits which we possess and
apply them to our future problems which are
being opened up by the present situation.
The first medicines were buds, flowers,
fruits, roots and barks of plants. Their effi-
cacy was due largely to their psychological
effect. It has not been such a long time since
the early American colonists believed in witch-
craft. The Indians had their medicine man,
and the Negro practiced voodooism, but the
modern physician is intensely scientific and,
having learned the cause and cure for a dis-
ease, artistically applies the necessary remedy.
The first man to master disease was Edward
Jenner, who conquered smallpox in 1796. Pas-
teur revolutionized the science of medicine. He
discovered Pasteur’s treatment of human be-
ings for hydrophobia. He pioneered the way
into the beginning of bacteriology. When he
overthrew the time-honored dogma of the
spontaneous origin of disease — the shining
era of modern medicine began.
Robert Koch made bacteriology a science
and discovered the bacillus that caused tubercu-
losis.
Lord Lister, the British surgeon, saw the
application of Pasteur’s discoveries to surgery
and elaborated the sterilizing routine that has
given the world the brilliant chapter of anti-
septic surgery.
Welch was a discoverer, scientific teacher,
a master organizer of research and teaching,
who was largely responsible for the systematic
development of scientific medicine in America.
Florence Nightingale’s life work in hospital
reorganization and the creation of systematic
training for nurses marked the turning point
in the attitude of society toward hospitals and
nursing.
Crawford W. Long is known as the father
of ether anesthesia, the most merciful of dis-
coveries, which released the surgical patient
from operative pain and made possible a re-
fined and deliberate operative technique.
631
632
Medical Progress — Crawford
May, 1946
Ehrlich laid the foundation of the theory
of immunity and created a powerful chemical
remedy for that most insidious and destructive
social disease.
Walter Reed and his associates in Cuba
proved that yellow fever spreads by the bite
of a mosquito, and brought about the eradica-
tion of that dreaded pestilence from southern
cities.
John B. Murphy, the Mayo brothers, Da-
costa, Samuel Gross, Crile and many others
blazed the way for modern surgery in America.
The great advancements which medical
science have affected in the treatment of dis-
ease during the past thirty-five years are
reflected in what physicians consider to be
the most important drugs today compared with
those used in 1910. Leading physicians listing
the ten most important drugs used in medi-
cine in 1910, chose them in the following
order :
1) ether, 2) morphine, 3) digitalis, 4) diph-
theria antitoxine, 5) smallpox vaccine,
6) iron, 7) quinine, 8) iodine, 9) alco-
hol, 10) mercury.
Tremendous advancement has occurred in
the field of therapy since 1910. So much in-
deed that it is almost impossible! to list today
ten individual remedies which might be con-
sidered the . most useful in medical practice.
In an effort to determine what leaders in
medicine might choose as most important in
1945, the editor of the Journal of the Ameri-
can Medical Association addressed a com-
munication to some of the professors of medi-
cine in leading medical schools. The largest
number of replies put penicillin first.
Five of the physicians placed morphine
first. Many added to morphine the names of
some of the barbituric acid derivatives. To-
day, instead of single drugs, we find families.
Ether still merits a place on any list of im-
portant drugs, but the anesthetist has access
to nitrous oxide-oxygen, cyclopropane, ethy-
lene, local anesthesia, spinal anesthesia, as
well as the basal anesthetics injected directly
into the blood.
Digitalis still holds a place among the most
important remedies.
The diphtheria antitoxin of 1910 is now
supplemented by innumerable antitoxins and
vaccines established as specific against certain
infections.
New on the modern list are blood plasma,
whole blood for transfusion, gamma globulin
and other blood derivatives.
Little was known in 1910 of gland products.
Today, the life-saving properties of insulin,
liver extract, estrogenic hormones, adrenalin
and thyroid are unquestioned.
The vitamins must be included in any signif-
icant list because of their specific virtues in
deficiencies such as rickets, scurvy, pellagra,
and beri beri.
Questionable on any modern list would be
arsphenamine, if penicillin develops as is an-
ticipated-ih the treatment of syphilis. Since
malaria appears to be the most widespread
of all diseases, quinine and atabrine must re-
tain an important place. •
A 1945 list of the most important remedies
might be: 1) penicillin and sulfonamides, 2)
whole blood, plasma and blood derivatives,
3) quinine and atabrine, 4) ether and other
anesthetics, morphine, cocaine, and the barbi-
turates, 5) digitalis, 6) arsphenamines, 7) im-
munizing agents, antitoxins and vaccines, 8) in-
sulin and liver extracts, 9) other hormones,
and 10) vitamins.
Actually the choice of the most important
remedy depends on the condition with which
the physician is confronted. For malaria there
is no question about the value of quinine and
atabrine ; for asthma, epinephrin or amino-
phyllin would seem most important; for amoe-
bic dysentery, emetine or carbarsone would
be the choice. If the patient just happens to
have indigestion, baking soda might be con-
sidered the sovereign remedy.
So great then has been the advancement
of therapy that the choice of the ten most
important remedies in medicine would baffle
any assemblage of experts.
All physicians might well take pride in the
accomplishments of medicine in the past quar-
ter century. The past decade has been more
fruitful than any period in the history of
medical research. One after another, glamorous
new weapons against death have tumbled from
research laboratories. Diseases once considered
100 per cent fatal have yielded; pneumonia,
former destroyer of 100,000 American lives a
year, has ceased to be dreaded.
Penicillin is tb,e queen of all the new reme-
dies— bacteria seem to fail to acquire re-
sistance to penicillin as they do the sulfa
drugs. The two are active against approxi-
mately the same group of diseases, with
penicillin additionally effective against syphil-
is, heart infections and a few others.
We are now hearing about streptomycin.
This gallant new drug takes up where peni-
t-' . tj . Vy. b‘- *-• '4
May, 1946 Socialized Medicine— Wall
633'
" :* r l . s: >.• •» ibmjjjrsq
cillin leaves off., Jt ^tt^cjcs , a^glq, c^ss 9^
microbes ’not .toucbe^ by^^^icykn 9srdgul%j
namely, influenza,. q^^n^|e^|^al ,4i^%
typhoid, .dysqntery,
possibly , .tuberculosis, :?n9bnf,oofc b#fJt itt9mvotq
,If early, trials are,0 any >n
streptomycin is made .^vaiiabj^ ^0 f]tie .^nbli.(|
it should make medical. ^mtqry. .<^^5, .„olfT
Swift and spectacular , ^ ^^^hef^.jrqcent
progress in medical discovery, "^jcgery has
quietly kept step.r .Surgeons rare ^performing
operations considered impossible a short time
ago... I..'.' '
The recent session of Congress appropriated
$300,000,000 for the establishing of a cancer
research laboratory, where it is expected to
engage most of the leading experts of the
world in an endeavor to conquer that terrible
disease that is making such inroads on the
health of humanity. Cancer is no respecter of
persons. May those wild cancer cells meet an
exploding atomic bomb.
The only effective weapon against cancer
now is an early diagnosis and: a ^Har$ un-
fju ■•c.'i'idc fcigo ■ iuf jimans
sparing surgeon s knife.
>T»i>.nu ■: • -V- f -»vyr-.i f *«?£:»! f.»jK
. s ..:\Yhat . of . the f utune of medicine ? r. ?The .only
safe. , prediciipn is that, there i^ ^ limit. ‘to
the- accomplishments t^aj0 are bossibje, '7"
“When people have learned .to eat to live,
instead: . . of ; % Jiving to.^e^,, whpn^ .they have
learned.. that wopry /m.akes f he biood pressure
pun ..high,.- room at the
tubercular sanatorium . to accommodate every
active T. B. . patient, preventing the spread
qf that disease, when cancer R has been con-
quered and when heart disease . jias been re-
duced to a minimum, then wq will approach
a medical millenium. Preventive medicine
dreams of the time when there shall be no
unnecessary suffering and no premature
deaths; when the welfare of the people shall
be our highest concern; when humanity and
mercy shall replace greed and selfishness; and
it dreams that all these things will be ac-
complished through the wisdom of man. When
young men .have visions, the dreams of the
old men come true.”
What Socialized Medicine Means to Mississippi*
j. P. WALL, M.D.
Jackson, Mississippi
That great Frenchman, philosopher, drama-
tist and man-of-letters, Francois Marie
Voltaire, said
“. . . . Nothing is more estimable than
a physician, who, having studied na-
ture from his youth, knows the prop-
erties of the human body, the dis-
eases which assail it, the remedies
which will benefit it, exercises his
art with caution and pays equal at-
tention to the rich and the poor.”
Everyone has an innate urge that he may
attain security, be this in the economical,
social or health stratum, but down in the
depths of everyone’s soul there is a con-
sciousness that such an attainment must be
consistent with that freedom, so dearly bought
and handed down as an imperishable heritage
by our forefathers, and so strongly is the
*Read before the public session of the Missis-
sippi State Medical Association on May 14, JL 946^.
Jackson, Mssissippi.
American indoctrinated with this belief that
be is unalterably opposed to any form of
government that bears the stigmata of the
totalitarian concept.
Truly can the doctor say-
“Lord of myself, accountable to none,
But to my conscience and my God
alone.”
Political medicine ignores and runs counter
to the basic principles that have placed
American medicine in a position of unquestion-
able leadership, that have given to the Ameri-
can people the most effective and most
widely distributed care available anywhere at
any time. According to Surgeon General
Parran of the United States Public Health
Service, “Our nation’s health has never been
better than it is now.” In 150 years the
average number of years a man will live has
been doubled. In 1790 the average life was
thirty-five years, today it is sixty-two years.
During this period typhoid fever has almost
disappeared; smallpox has been subdued,
634
Socialized Medicine — Wall
May, 1946
diphtheria practically conquered; pernicious
anemia, tuberculosis, diabetes and many
smaller ailments have been brought under
control. In 1944 the United States had the
highest general level of health and the lowest
death rate ever known for a like number of
people under similar conditions.
That American medicine can and will take
care of its own housecleaning, if and when
necessary, is demonstrated by the impressive
elevation of the standards of medical educa-
tion since the turn of the century. In 1906
■medical diploma mills were rife and in many
of these institutions the payment of fees,
rather than scholastic attainments was the
sine qua non for graduation.
Today American medical schools are the
finest in the world — all this the work, not
of the government, but the medical profes-
sion.
“American doctors”, according to Governor
Bricker of Ohio, “have made eminent prog-
ress in caring for our health. Medical organi-
zations and private hospital groups are mak-
ing substantial progress toward the goal of
providing adequate medical and hospital care
for all.
For the past three years there has been
much agitation in the Congress for compulsory
health insurance. This has been led by a Ger-
man-born senator, Senator Wagner of New
York, abetted by Senator Murray of Montana
and seconded in the House of Representa-
tives by Congressman Dingell of Michigan.
These measures, if successful, would ultimate-
ly subordinate the medical profession to the
unenviable status of mere hirelings of a politi-
cal bureaucracy, controlled by laymen. So
far these sinister attempts have failed, be-
cause an aroused American people do see the ,
fallaciousness and the speciousness of the
arguments, and are not unaware of the dire
consequences that would inevitably result
from such measures.
President Truman, in a recent message to
the Congress on health matters, expressed his
approval of such measures, but Mark Sullivan,
a famous columnist, said, in speaking of the
President’s message, -<
it is the most revolutionary
proposal for legislation that has been
sent to Congress since the National
Recovery Act of 1933.”
The latest of these bills is known as Sen-
ate Bill 1606, and without a doubt is state
medicine in a most pernicious form. It has a
preamble of rhetorical aspect; is over-flow-
ing with expansive and disinterested humani-
tarianism. “To provide for the general welfare ;
to alleviate the economical hazards of old age,
premature death, disability sickness, unem-
ployment and dependency — to encourage and
aid the advancement of knowledge and skill
in the provision of health service — to make
more definite provision for the needy aged,
the blind, dependent children and other
needy persons” — in short it provides govern-
mental care “from the womb to the tomb.”
In 1943 the National Physicians’ Committee
made a rather comprehensive survey, and in
a study named “The Peoples’ Opinion on
Medical Care” has presented some very
positive conclusions, the most prominent
among them being the fact that the people
do not want compulsory health insurance. This
survey is independent and its accuracy can-
not be questioned, and the overwhelming ma-
jority of our people are with the medical
profession on this all important question.
This Senate Bill 1606 is to cost $12,000,000,-
000.00 annually, and one quarter of this
astronomical figure is for “free medical care”,
“free hospitalization” and “free medicine” to
over 110,000,000 people.
WHAT DOES THE WAGNER-MURRAY
DINGELL BILL PROPOSE?
1) To hire doctors, specialists, dentists,
nurses, laboratory technicians and estab-
lish their rates of pay.
2) To designate which doctors shall be
specialists.
3) To determine the number of individuals
for whom any physician or dentist may
provide service.
4) To determine arbitrarily what hospitals
or clinics may provide services for
patients.
5) In an over- all manner to furnish care
for over 110,000,000 people, and this
without any distinction as to whether
the patient is able or unable to pay
for such services.
The objectives are indeed acceptable, but
the method of attaining them is decidedly
objectionable.
President Truman in his address to the Con-
gress stated that to attain this goal it would
take 100 years, but the medical profession
knows that these figures are entirely too pes-
simistic, for if the California plan could be
Socialized Medicine — Wall
635
May, 1946
applied to the entire nation, this result could
he attained in only two years. California has
faced this threat of state medicine for seven
years and has successfully met its menace
by undertaking a pre-payment plan of health
insurance which is to be so extended that
comparatively few of its people will be left to
demand state medicine.
WHAT DOES POLITICAL MEDICINE JHE AN
FOR SICK PEOPLE?
IT MEANS:
1. Fees are paid by the government to
doctors, presumably working eight hours
a day. The emergency sickness must wait
until the doctor is back on the job.
2. The doctor may not be the choice of the
patient, but the doctor assigned by the
political bureaucrat. .
3. The doctor can not have a personal in-
terest in the patient, who comes to him
not by choice but by compulsion.
4. The doctor necessarily is less proficient
because he is forced to prescribe reme-
dies fixed by bureaucratic superiors.
5. Since the doctor’s job is by political pre-
ferment, he is more interested in pleas-
ing or appeasing his political bosses than
in securing a cure for the patient.
To this there is one question, with an ob-
vious answer: “Do you want medical care for
the sick, to provide for bureaucrats, politi-
cians or doctors?”
WHAT DOES POLITICAL MEDICINE MEAN
FOR THE DOCTORS?
1. Shorter hours.
2. Little incentive to become skilled. Ad-
vancement would depend upon political
influence rather than skill.
3. Would not develop initiative, would be
in a rut.
4. Have little or no personal interest in
the patient, who is compelled to visit
him.
5. This eventually means incompetence,
professional deterioration and forfeiture
of self-respect.
President Truman’s citation of draft rejec-
tions as a compelling reason for the introduc-
tion of compulsory sickness insurance in the
United States loses its plausibility on .com-
parison with draft rejections in Britain, where
this insurance prevails. In this country the
rejections for military service were about
Great Britain, Which had had compulsory sick-
ness insurance since 1911, the draft rejections
were much higher. Rejections for the ten-year
period ending with 1936, according to the an-
nual report of that year, showed of 677,515
who were served with notice papers, 400,775
were rejected, or 59 per cent. Even allowing
for the effects of a lower standard of living,
if Britain after twenty-five years of sickness
insurance had a rejection rate of nearly twice
that of America, there seems to be little argu-
ment in the draft xeJections for socialized
medicine. Jj_.
After V-E Day, Colonel Edward D.
Churchill, Allied Mediterranean Forces Surgical
Consultant, toured six German military hos-
pitals and their areas. His overall conclusion
after inspecting these areas was that German
handling of wounded was about twenty years
behind the American procedure. This, mark
you, is a tremendous backward step from
Germany’s once proud record as world leader
in medicine and surgery.
“This began to happen soon alter Hitler
saddled his brand of totalitarianism on Ger-
many. German medicine withered and in due
time the German armed forces paid, in the
form of greater death tolls than they needed
to have suffered.”
A modified form of this socialized medicine
is being tried out in England, this being the
pet measure of the late Lloyd George, and it
is proving very unsatisfactory because:
1. A panel can, and is, bought, after ad-
vertising its merits, in the open market
by the highest bidder, such sale being
determined not by the merits of the pur-
chaser or the desire of the patient, but
solely by the amount of money a pros-
pective purchaser is willing to pay.
2. Such a trafficking in the sick man’s wel-
fare is bound to decrease-, the patient’s
confidence in the panel docter, because
the patient realizes that he is just a
chattel and can, and probably will, be
farmed out to another and higher bid-
der.
3. Because of the large size of the panels,
the doctor has little time for recreation,
practically none for postgraduate study
and consequently deteriorates in effi-
ciency.
Another example of government’s failure
in the care of its medical charges is shown
by the miserable record of the United Stated
636
Socialized Medicine — Wall
May, 1946
Veterans’ Administration
.nu.r:;>: a xat
twenty years. During this time millions • of
dollars have teen spent to provide tire best
during the past
of
spent to provide the J best
medical carp for the veterans. Over a quarter
of a billion dollars ' has been spent5 for hos-
pitals alone. Money has been no ’ “object, but
the, veteran has received notoriously poor
treatment. The hospitals are overcrowded ;
physicians and technicians are unnecessarily
loaded with red tape, and many are profes-
sionally incompetent. Notwithstanding’ this the
government1 has Operated the Veterans’ Facili-
ties for over twenty years, ’with unlimited tax
funds, not a "single1 institution ha& been ap-
proved by the American Medical Association
jsi-i .bMiloiu J. _ J 7
in mind the hiblichf ihjuhc tiohf ‘ ‘P»y their fruits
ye shall * lmow1 ‘thent. **** **** ^ 4. :
? J1 {J*hfsfaiu8s$pm » ,<:annot
mfo^ifc® tern 4 ?Mpite
of the fa^t °f Money
9*f. $?<, ww ?f the
V eterans’ Administration, Jiqw, can it provide
adequately , for. ^ the health ^ of > ,140 million , peo-
. under 'Jjjyjjgg^ ’of the ^agrier-Murray-
Dinge^ Wf’-nsd,™ /
As an illustration o^ .the care rendered by
veterans’ hospitals for: tubercular . patients a?
compared with that rendered by other institu-
tions/ compare -the following figures:
“Even as an individual, without benefits of
insurance, one can provide fqr a limited
amount of miscellaneous services, operation
costs and seventy days of hospitalization for
as low as $17.00 per year, depending upon the
age and state of health, through private in-
surance companies. Barnum once said that a
sucker is born every minute. Along with the
sucker is born a politician, and nowadays a
“progressive” to beat his drums for every
measure th&t extends the power of the state
even into the dnost intimate parts.
It might be asked who is back of the bill?
The answer is very obvious. It is supported by
1. Profhssihhaf Welfare Workers who expect
!7 5' 'tfdiiihttimq *
Arrierl^ah^ ^ldei"atibh" bf TLabor artd the
b&mmlttee {dfi'5 Ilidhsthral ^Organization,
bt)ti if MloM Would 1 thus' Inbrease their
strafipe hblS^^knibficari lib&f ties.
American Publr^We!MthifAssobMtidn and
the Nati'orfal'fle^fth Afesbfcihtibn1, a large
perceM&g^F' #f Whbm?ai*e 'not eVen medi-
***» - ] ■ •• :
Social SecMrit^5 Adffiihisffdtidh. j :
All “Leftists” Who think, And ; tightly
so,’ that tHis is; a definite plan that will
evaluate info the communism, that will
insure1 the logical sequence of totali-
tarianism.
On the other side of the ledger, see who op-
pose this measure.
2.
3.
4.
5.
RECORD OF TUBERCULAR PATIENTS— ' ‘
DISCHARGE!) AS‘:“ARRESfteB^-n:;:
Veterans’ Administration Hospitals- ->4... A 2.3%
Hospitals of New York State .25.6%
The taxpayer has, or should have some
“say” - about this matter. He is being taxed
for those who are able to pay as well as the
indigent, v^oni !&. : :: v : : ■
There; are sq*he urgent needs in medicine,
and among themunay be enumerated:
1. There is need not for just more medical
care, but more medical care of a higher
; quality. ^
2. A propel j distribution of medical men
and facilities.
3. Lessening cost of illness.
The eminent columnist, Dorothy Thompson,
said:
“Ordinary bouts of sickness in the average
family can be dealt with ; the real crises are
those that require hospitalization and surgical
services, and those usually occur only a few
times in one’s life.
It is opposed by
1. American Medical Association.
2. American Academy of Pediatrics.
3- American College of Surgeons.
4. American College of Physicians.
5. American Bar Association.
6. Catholic Hospital Association.
7. National Catholic Welfare Association.
8. Central Medical Society.
As a fair and dispassionate judge, whose
interests would the average citizen think
would be best served by these two groups ?
“Private practice of medicine is an essential
part of private enterprise and at the same
t'me is a public responsibility. It must be re-
membered that the socializing of medicine is
a general attempt to socialize all enterprises.
After all, it is the public who will be socialized
and the public who will be subjected to the
type of medical care resulting from bureau-
cratic control. Medicine always has and is now
motivated by the desire to be of service to
the public — to achieve this ideal, medicine
must be free.”
May, 1946 Socialized Medicine — Wall 637
' „ . . _ #v -
Proponents of this bill have denied the dic-
tator charge.4 While there is provided an ad-
visory council of sixteen members,. -to < be ap-
pointed by the Surgeon General, the fact re-
mains that the Surgeon General is under no
obligation to accept their advice, and further-
more, from his decision there is no appeal, for
the simple fact that the Surgeon General ap-
points his advisers. Despite the claim of the
advocates of this bill that private practices
will not be destroyed and that the patient will
still have, the free choice of his physician, the
bUlj does provide that the patient can not have
free choice of his own physicians under the
following circumstances :
1. , If his physician has refused to sign up
as a government agent.
2. If his physician, although he has signed,
already has the maximum number of
patients allotted by the Surgeon General.
3. If the physician, whom he 'has chosen,
cannot for any1 reason take' care of 'him.
4. Furthermore the Surgeon1 General has
the power to allocate such patients on a
pro rata basis among the medical prac-
titioners in any area.
Such a bill would force hospitals to reduce
their standards, for the bill provides that the
ratient “will receive only the use of the ward
or other least expensive facilities.” Experience
has demonstrated that during the Federal
Emergency Relief Administration doctors car-
ing for patients in the government rolls were
not permitted to prescribe the drugs of their
choice, but were restricted to the use of medi-
cation on certain lists. It is not a question
■of the medicine the doctor thinks is indicated,
but rather the medicine some bureaucratic
head thinks will cost the least.
“Whatever is right can be achieved through
the irresistible power of awakened and informed
public opinion. Our object, therefore, is not
to inquire whether a thing can be done, but
whether it ought to be done, and if it ought
to be done, to exert the forces of publicity
that public opinion will compel it to be done.”'
The London Lancet in speaking editorially
of the socialization of medicine in Britain
said:
“The evil to be apprehended is in brief
a rigid standard of service in * which
the good, or moderately good, regu-
larly defeat the best; in which red
tape slows all movement; in which
the sweetness of originality is wast-
ed on a bureaucratic air; and in
which the staff, sinking into medioc-
rity, work no longer, no harder than
is expected of them .... all of this
is inevitable under the arrangements
that do not permit flexibility, va-
riety, responsibility, enterprise and
enthusiasm. To the profession of indi-
vidualists the whole condition of
government control is repugnant.” G
Medicine and the profession do take the
responsibility of furnishing the science, skill
and art of both preventive and curative
medicine. The medical profession- alone is the
vehicle for the application of these Several
services, and should never be shackled by lay-
men, whose sole prerequisite is political
ascendency.
The American Medical Association does have
a plan under which professional auspices
would provide adequate care for all the peo-
ple at a price they could afford to pay— this
means national health program with empha-
sis upon nation-wide organization of locally
administered prepayment ' medical plans spon-
sored by local medic&f societies. This is out-
lined in its “Ten-P6iht :: 'Plan’ V and such a
plan should cobr diriate' the activities of all
state prepayment plafis and 0
1. Should be organized as non-profit stock
ehf er ptises.
2. Should be chal^'rdd in one state (this
was done this ihonth in Illinois) and
licensed to do business in all the states.
3. Should be under ; medical control and
integrated with'1 hospital plans.
We do not need federal interference in state
and local health, but progress can and should
be made by
1. Attacking the causes of unemployment
and disability.
2. Improving social, economic and working
conditions, generally.
3. Improving food, housing, recreation and
other environmental conditions influenc-
ing health.
4. Encouraging thrift, savings and private
insurance.
5. Expanding the number and coverage of
voluntary medical and hospital service
plans through which Americans can bud-
get the costs of sickness and the best
care can be made available for all.
Summary and Conclusions 7
1. The meaning and implications of S 1606
can not be ignored.
2. The American people want none of the
538 Socialized Medicine — Wall May, 1946
national government’s meddling in the
vital field of medical service.
3. The- American people know about the
desire for and demand for a method for
the payment of medical care costs. This
must be met.
4. It is not exclusively a medical responsi-
bility. It is also an economical problem.
5. The American people understand and
believe in our effective system of per-
sonalized medical care.
6. Equally involved in the final settlement
are all of the professions, the insurance
companies, American Labor, all of busi-
ness and all of industry.
7. Methods have been devised; mechanisms
have been perfected. Plans have been
tested. They have proved satisfactory to
a previously unbelievable extent. They
are adequate to the need. The period
of experimenting is at an end.
The people have faith in their doctors, the
doctors have faith in the extension and pow-
er of voluntary insurance. There is no need
of this revolutionary change and there should
I)e no penalizing of all for the benefit of the
few.
What Socialized Medicine Means to Mississippi
Doctors
1. Medicine would be subject to the dic-
tates, rules, regulations and red tape im-
posed by bureaucratic control.
.2. Medicine would constantly be at the
mercy of lay control, political ap-
pointees, subject to the complaints of
disgruntled patients, as well as the per-
sistent demands of malingerers, seeking
.« certificates of illness.
3. Public dependence would be encouraged.
4. The burdens of taxation would be in-
creased.
5. The doctor would become a mere hire-
ling of a layman.
6. The standards of medical practice would
be lowered, and medical progress hin-
, / dered with a consequent deterioration
of medical skill.
7. Under the supervision of the Surgeon
General there would result a regimen-
tation of physicians and patients.
8. There would be a substituting of politi-
cal for personal service.
It matters not how straight the gate,
How charred with punishment the scroll,
I am the master of my fate,
I am the captain of my soul. 8
REFERENCES
1. Voltaire — A Philosophical Dictionary — Physician.
2. Satire, addressed to a friend — John Oldham.
3- Editorial Collier’s Weekly — September 4, 1945.
4. Ernest E. Irons, Journal American Medical Asso-
ciation, July 7, 1945.
5. Editorial from pen of Wm. Randolph Hearst
6. London Lancet — March 23, 1946-
7. Challenge to Private Enterprise, Page 17 Publi-
cation— National Physician’s Committee.
8. Henley — “Echoes” IV.
♦Read before the annual session of the Missis-
sippi State Medical Association, Jackson, Mississippi,
May 14, 1946.
The first wealth is health. Sickness is poor-
spirited, and cannot serve anyone ; it must
husband its resources to live. But health
answers its own ends, and has to spare; runs
over, and inundates the neighborhoods and
crooks of other men’s necessities.
Ralph Waldo Emerson
One out of every twenty-five babies in our
country is “illegitimately born”, and the moth-
ers of these children — half the time — are
themselves little more than children, between
fifteen and nineteen years old.
The difficulties these unmarried mothers
■■ vw • y it ;
( , and their children face present a challenge to
hundreds of communities.
Cavernous Sinus Thrombosis with Recovery*
REPORT OF CASE
Charles M. Murry, Jr. M.D.*
Birmingham, Alabama
Prior to the advent of chemotherapy, re-
covery in cases of thrombosis of a caver-
nous sinus were extremely rare.
It is the purpose of this paper to report a
case of; cavernous sinus?- thrombosis successful-
ly treated with sulfadiazine, penicillin and
continuous heparin infusion.
A detailed description of" the cavernous
sinuses and the clinical significance of their
tributaries is contained in a paper by Grove. 1
A. B., a colored girl aged 8 years, was
admitted to the hospital on August 27, 1945,
with the following history: Nino days prior
to admission she developed a small pimple on
her right upper eyelid. This became larger
and she picked it three days after its onset.
The next day her eye was greatly swollen and
tender. She was treated by her family physi-
cian, who gave her some sulfa tablets and
eye drops. The family was told that her
temperature at that time was 104°. The eye
became even more swollen and on the morn-
ing of admission she complained of a sore
neck and “talked out of her head.” iShe had
no chills and no convulsions. There were epi-
sodes of vomiting on the third, fourth, and
fifth days of her illness.
Physical examination revealed a fairly well
developed, well nourished colored girl lying
on her right side with her knees drawn.
Temperature was 103.4°, pulse 130 and respi-
ration 24. The right eyelids were markedly
swollen, soft and tender. There was marked
bulbar conjunctival injection. The right pupil
was large, round and did not react to light.
There was paralysis of nerves III and VI. The
right fundus showed slight papilledema. The
mid -forehead region was swollen, tender and
fairly soft but no areas of fluctuation could
be palpated.
The mucous membrane of the throat was
injected and the tonsils were red and en-
larged. The neck was moderately stiff. There
was a slight increase in breath sounds in the
left base posteriorly but no rales were heard.
♦Department of Ophthalmology
Medical Colleg-e of Alabama
.Lniversity of Alabama, Birmingham, Ala.
There was marked voluntary abdominal spasm.
The Kernig and Brudzinski were positive.
On admission the blood showed 5,100,000
red blood cells with 84 per cent hemoglobin
and 28,000 white blood cells with 86 poly-
morphonuclear neutrophils, 13 lymphocytes
and 1 monocyte per hundred cells. The urine
showed a heavy trace of albumin and many
bacteria per high power field. The spinal
fluid showed 600 cells with 70 per cent
lymphocytes. A blood culture was taken.
The child was isolated and was given 1
gram of sodium sulfadiazine intravenously and
started on 7.5 grains of sulfadiazine every
four hours orally with an equal amount of
sodium bicarbonate. Penicillin 20,000 units
every three hours was also begun. At the
time of the initial spinal tap, 10,000 units of
penicillin were given intrathecally.
Eight hours after admission the tempera-
ture had become elevated to 105.0°. Within
twelve hours more it had dropped to 100.8°.
On August 29 a report on the blood culture
was received and showed no growth after
eighteen hours. A second spinal tap made on
August 29 showed 283 cells with 96 per cent
polymorphonuclear neutrophils and 4 per cent
lymphocytes. The blood Kahn was reported as
negative.
On August 29 continuous intravenous hepa-
rin therapy was instituted at 3:45 p. m. At
this time the blood clotting time was two
minutes. This clotting time was repeated at
regular intervals with the following figures:
August 29 5:45 p. m. six minutes
8:45 p. m. fifteen minutes
August 30 12:45 a. m. eighteen minutes
, 4:45 a. m. fifteen minutes
8:45 a. m. thirteen minutes
12:45 p. m. twenty-one minutes
5:30 p. m. nineteen minutes
In the evening of August 30 the right up-
per eyelid was incised and drained and a cul-
ture taken of the drainage. A pressure dress-
ing was necessary to control the bleeding. On
August 31 the sulfadiazine blood level was
reported at 8.6 milligrams per cent. The urine
showed a heavy trace of albumin and many
amorphus crystals. The blood showed 23,000
639
640 Cancer
-.r;. r. ■ ■ , • y /; ; / 7v g : . r
white blood cells with 70 per cent poly-
morphonuclear nfeutrophils, 28 per - cent
lymphocytes and 2 per cent monocyt.es* The.
temperature was 100°. . .
At 7 a. %. on August 31 the clotting time
w&£5 seventeen iMniites. At 3 P. m. the
needle Slipped from the vein and the ' con-
tinuous heparin infusion was -discontinued.
Wifnih four hours the blood clotting time
had dropped to four ; minutes.
. On September 4 the laboratory reported a
-culture of hemolytic Staphlycoccus aureus from
the drainage from the right upper eyelid. On
September 5 the blood culture showed hemo
lytic Staphlycoccus aureus after seven days’ in-
cubation. On September 6 the blood showed
-Baugh May, 1946
, . r
■> '■ \
8,600 white blood cells with 61 per cent poly-
indf'pidhuclear neutrophils. A spinal tap per-
,|or^ned on. September 7 showed 30 red blood
^cellsT ^Qn. September 12 a blood culture, which,
had been taken two days previously, was re-
ported as sterile. All chemotherapy was then
discontinued.
. -.j l
From September 4 up to the time of dis-
charge the temperature varied from normal
to 100°. The child was discharged on Septem-
ber 13 to be followed in the Ophthalmology
Clinic. She has been seen two times since her
discharge and, with the exception of a sixth
nerve paralysis, is getting along nicely.
. t
1. Grove, W. E., Septic and Aseptic Types of
Thrombosis iof the Cavernous Sinus, Arch-
Otolaryng-. 24:29 (July) 1936.
Cancer in the Female Reproductive System*
DOUGLAS D. BAUGH, M.D. F.A.C.P.
Columbus, Mississippi
The female reproductive organs constitute
favorable ground for the development of
cancer by reason of the variety of highly
specialized epithelial tissues present, by reason
or the inherent profound physiological changes
present and by reason of the trauma incident
to bearing children.
Approximately two-thirds of the eighty to
ninety thousand women who die each year of
cancer in the United States have cancer of
seme part of the reproductive system. Most
of these women die during or soon after the
reproductive period; that is, in the prime of
life and in the period of greatest usefulness to
their families.
Many millions are today being spent in can-
cer research. Until cancer is more fully under-
stood we must use the means already at hand
in prevention and early treatment. These
means are not inconsiderable.
Our ability toj recognize this disease in the
early stages is roughly proportional to the
accessibility of the affected part. For example,
the stomach is one of the most common sites
for cancer, yet the stomach is relatively in-
accessible, and routine x-rays, necessary in
early diagnosis here, are as yet impracticable.
* Read at the quarterly session of the Northeast
Mississippi Thirteen Counties Medical Society,
Tupelo, Miss., December 1945.
The female reproductive organs, however,
are relatively accessible to physical examina-
tion with the equipment found in almost every
doctor’s office. The x-ray is not routinely
needed; simple inspection and palpation are all
that is necessary to recognize the suspicious
lesion, and biopsy can then confirm or dis-
prove.
As to prevention, we can do much here as
compared to certain other regions of the body.
Especially is this true of carcinoma of the
uterine cervix, ninety-five per cent of which
cases develop in those who have been preg-
nant. The noted gynecologist, Gellhorn, stated
in 1934 that in women who have had their
children by Caesarean section, not a single
case of cancer of the cervix has thus far been
reported.
These facts go to prove that the most pro-
lific source of cancer here is the usually un-
avoidable lacerations of the cervix resulting
from childbirth. While any chronic irritatioi
predisposes to cancer, those resulting from the
passage of a fetus through the cervix partic-
ularly predispose. Every physician who de-
livers a mother participates in making a po-
tential cancer victim and thus has a very
grave responsibility to follow up the case and
eradicate any predisposing factors.
The practice of making immediate repairs
May, 1946
The Rh Factor — -Harrison
641
and of following up our cases at the end of
about two months for the purpose of clearing
up any residual irritations (usually by caut-
ery) must become more universal. The patient
and the doctor are here often mutually care-
less about this follow-up examination, which is
almost as important to the mother as the
actual delivery of the child.
The usual symptoms suggesting cancer, in-
cluding disturbances in the menstrual cycle,
abnormal discharges, etc., must be investigat-
ed; but since there are no reliable symptoms
of early cancer, we must look for signs.
Early recognition of cancer is the only
recognition of cancer worth while as a means
of saving life. What are the symptoms of
early cancer? The answer is: THERE IS
NONE. Pain, which the layman usually as-
sociates with cancer, is most unfortunately
not an early symptom. Abnormal discharges,
tumors and loss of weight usually indicate at
least a moderately advanced lesion. A serous,
or serosanguinous discharge and intermen-
strual or postmenstrual “spotting” are the
earliest clinical manifestations of carcinoma.
The Mayo Clinic states that ninety per cent
of the cases of cancer of the cervix that
come to their attention are incurable. Careless-
ness, timidity, ignorance of symptoms, and
fear on the part of the patient, no doubt, ac-
count for some of this percentage, but it is
all too true that thb majority of these lesions
are beyond the early stage when the symptoms
show up.
We believe that if the patient and the doc-
tor would cooperate to the end that every
woman who, between the ages of thirty and
sixty, has been pregnant, would have the re-
productive organs examined every six months,
the mortality of cancer in these women would
be only a small part of what it now is.
The logical conclusion here is obvious. The
cases that we can treat most effectively are
the ones that we look for and find in their
incipiency before symptoms develop.
The Rh Factor in Medicine*
V. B. Harrison, M. D.
University of Mississippi,
University, Mississippi
Unquestionably the reporting of the dis-
covery of the Rh factor in human blood
in 1940 has created more clinical interest
than any other hematological discovery since
Landsteiner’s report on blood groups in 1900.
The clinical fields primarily interested in the
Rh factor are pediatrics, surgery and ob-
stetrics.
Historical Note
In 1900 Ehrlich and Morganrath reported
the experimental production of iso-antibodies
in a goat. This was a fundamental discovery
because normally an animal will not produce
antibodies against tissues of its own species.
The same year Landsteiner reported the ex-
istence of normal iso -antigens and iso-anti-
bodies in human blood and thereby established
the basis for the four human blood groups.
Jansky in 1907 and Moss in 1910 classified
human blood into the now recognized four
groups. In 1911 von Dungern and Hirszfield
discovered the existence of subdivisions in
two of the four human blood groups and
showed that the four groups were inherited.
Landsteiner and Levine in 1927 reported the
discovery of the iso-antigens M and N in hu-
man blood cells. The existence of the Rh
iso-antigen in human blood was reported by
Landsteiner and Wiener in 1940.
Immunological Principles
An antigen is a substance which, when in-
troduced into the body by a route other than
by ingestion, will produce a new substance,
known as an antibody, and the two substances
will react together in a discernible manner.
Most antigens are proteins, but not all pro-
teins are equally effective in producing anti-
bodies. As a general rule, an animal will pro-
duce antibodies against the tissues of an ani-
mal of a different species (hetero-antibodies),
but it will not produce antibodies against the
tissues of another animal of its own species
(iso-antibodies). However, acquired and nor-
mal iso-antibodies do exist, although they are
rare.
Normal and acquired antibodies, even those
in the same category of action, vary quali-
tatively and quantitatively, especially in their
titers or concentrations, in their duration or
span-of-life in the body of the host, and in
The M Factor — Garrison
642
their temperature-of -reaction in vitro. For
example, normal antibodies usually have a
low, constant titer, a permanent existence,
and they react best at relatively low tempera-
ture, while the acquired antibodies usually
have an initially high titer which gradually
falls, a limited body existence, and they
usually react best at body temperature.
The important human normal isonantigens
are those found in the red blood cells, namely,
those designated “A” and “B”, “M” and
“N”, and “Rh”. The only normally occurring
iso-antibodies of importance are those found
in the blood serum and, sometimes, in the
tissues of man, namely, the alpha and beta
iso-antibodies.
Tl A and B liso-antigens and the alpha
and btitla iso-antibodies are related in certain
ways’ tb form the four blood groups. As the
iso-antigen A reacts with the iso-antibody
alpha and the iso-antigen B reacts with the
iso-antibody beta, it is obvious that a given
iso-antigen and its specific iso-antibody can-
not co-exist in an individual. The combina-
tion of these iso-antigens and iso-antibodies
in the four blood groups are, as follows: (1)
A plus beta, (2) B plus alpha, (3) A and B
plus no iso-antibody, and (4) no iso-antigen
plus alpha and beta. The following chart il-
lustrates these' facts and the percentage of each
group in the average white population :
CLASSIFICATION, COMPOSITION and PERCENTAGE OF BLOOD GROUPS
Landsteiner
Jansky
i
Moss
| Iso-antigens
| in RBC
Iso-antibodies
in serum
|
Population
distribution
0
[ 1 1
IV
I
i —
| alpha and beta
i
i
45%
A
1 2 |
II
1 A
beta
i
41%
B
1 3 |
III
1 B
alpha
i
10%
AB
1 4 |
I i
I
| A and B
i
—
i
i
4%
The cross-reaction schedule is, as follows,
with the pluses indicating agglutination and
the minuses indicating no agglutination :
BLOOD GROUPING REACTION CHART
Cells from| Serum from group-
group-
0 |
A |
B
| AB
i
i
alpha |
& beta |
beta |
alpha
| zero
o
A |
i
- i
+ i
i
- i
4- |
—
B |
+ 1
+ i
—
—
AB
+
+ ■ i
i
+
—
As group
0 blood
contains
no iso-antigen,
its cells will not be agglutinated by the iso-
antibodies of any other group, therefore,
group O is designated as the universal donor
group. As group AB blood contains no iso-
antibodies, its serum, will not agglutinate the
cells of any other group, therefore, group AB
is designated as the universal recipient. The
universality of group O and AB is true only
when their iso-antibody titer and that of the
other participating party are relatively low
and when the blood is given or received
slowly.
The iso-antigens M and N occur in the red
blood cells, either individually or in combina-
tion, that is, as M, N, or MN. Everyone has
one or the other or both of these iso-antigens
in his red blood cells. There are no corres-
pondent iso-antibodies in the human blood
serum for these iso-antigens and usually a
person does not develop acquired iso -antibodies
as a result of blood transfusion. Therefore,
while these factors are important in legal
medicine, they have small significance in clini-
cal medicine. While the M and N factors are
common to all blood, they bear no relation-
ship to the order of the four regular blood
groups and their iso-antigens and iso-anti-
bodies.
The Rh iso-antigen of human red blood cells
is so-called because it reacts with hyper-im-
mune serum prepared by immunizing guinea
pigs with the red blood cells of rhesus macasus
monkeys. About 85% of the population have
Rh iso-antigens in their red blood cells, and
the distribution of the Rh iso -antigen is fairly
uniform within the four regular blood groups
and by sexes. Under normal conditions, human
blood serum contains no specific anti-Rh iso-
643
May, 1946 The Rh Factor — Harrison
antibodies. The Rh factor is transmitted by
heredity as a simple mendelian dominant trait.
- While the Rh factor is an iso-antigen, and
one of not high antigenic quality, the re-
peated introduction of Rh positive blood into
a Rh negative person will stimulate the pro-
duction of specific anti-Rh antibodies in the
recipient. It is the presence of these anti-Rh
antibodies in the body of a Rh positive indi-
vidual which causes the conditions attributable
to the Rh factor.
The Rh Factor in Pediatrics
The chief interest of pediatriqs in the Rh
factor is due the part that the Rh factor plays
ir. a hemolytic anemia of the newborn known
as erythroblastosis foetalis. The chief charac-
teristics of erythroblastosis foetalis are pro-
gressive intra-uterine hemolysis of fetal blood
and familial incidence. Clinically the disease
may be manifested in one of three forms,
namely (1) fetal hydrops, • the most serious
form, (2) icterus gravis, the most common
form, and (3) a mild, frequently unrecognized
anemia of the newborn. The disease is rela-
tively rare; about one case occurring in every
two or three hundred full-term deliveries. How-
ever, the same mechanism causing erythro-
blastosis foetalis may explain the cause of
many early and late fetal deaths.
The cause of erythroblastosis foetalis is an
Rh positive fetus in an Rh negative mother.
The Rh negative mother is immunized trans-
placentally by the Rh positive fetus. The exact
method of transplacental immunization is not
altogether clear, but two possibilities occur,
namely: 1) There exists a placental defect
which allows a maternal transfusion of fetal
blood or, 2) After intra-fetal physiological de-
struction of fetal erythrocytes, some of the
fetal Rh factor passes through the placenta
into the maternal circulation. In either event,
the Rh negative mother responds to the par-
enteral introduction of this foreign protein bv
the production of an appropriate antibody.
This maternally produced anti-Rh antibody is
transferred across the placenta to the fetal
circulation where it reacts with the fetal Rh
positive erythrocytes to cause their destruc-
tion. Thus, there ensues a vicious cycle of
maternal hyper-immunization and fetal
hemolysis and hyper-hematopoiesis.
Since the Rh factor is inherited as a sim-
ple mendelian dominant, the prospects for an
Rh positive child is great, if either parent is
Rh positive. This is especially true since the
Rh factor is evenly distributed between the
sexes and the four blood groups. Briefly, the
expectancy of an Rh negative offspring from
Rh positive and negative parents is, as fol-
lows:
Rh+ x Rh+ — 7.6% of children Rh —
Rh+ x Rh — — 27.6% of children Rh —
Rh — x Rh — — 100.0% of children Rh —
Not all of the cases of erythroblastosis
foetalis are explained by the Rh factor, that
is, Rh+ fetus and Rh — mother. In some cases
the reverse situation holds true, that is, the
fetus is Rh negative and the mother is Rh
positive. In most of these cases the blood
serum of the Rh positive mother contains an
antibody which reacts with the cells of the Rh
negative child and with the cells of the Rh
negative father. Such a serum has been desig-
nated anti-Hr, a reversal of the Rh letters,
because the reaction is a case of the Rh fac-
tor in reverse.
The intra-uterine treatment of erythro-
blastosis foetalis is unsatisfactory at present.
The neonatal treatment of the erythroblastotic
infant is by transfusion. In the transfusion
treatment of the erythroblastotic infant, more
than ordinary laboratory and technical care
is indicated. First, it should be remembered
that the infant’s blood is full of anti-Rh anti-
body obtained from the mother before de-
livery. Therefore, if Rh positive blood is used
in the transfusion, the donated cells will be
hemolyzed by the anti-Rh antibodies in the
infant circulation. However, some authorities
advocate giving large doses of Rh positive
blood with the exception of sacrificing some
of the donated cells in order to exhaust the
anti-Rh antibodies in the infant circulation.
Such a practice is not without risk to the
child, for it places an additional load on an
already over-burdened kidney and liver. The
practice of using the mother’s blood for neona-
tal transfusion is contra-indicated in this
disease, because to do so will introduce addi-
tional anti-Rh antibodies into the infant’s cir-
culation and precipitate a hemolytic crisis.
The desirable blood would be that from an Rh
negative male or nulliparous female who has
never had a blood transfusion. Such blood,
if it were otherwise compatible, would not
likely contain anti-Rh antibodies and the cells
would support the infant’s circulation. If the
correct blood group donor is not available, a
group O, Rh negative may be used.
644
The Rh Factor — Harrison
May, 1946
The Rh factor in Surgery
Blood transfusion is now firmly established
as a therapeutic measure and it is widely used
on the least provocation. It is a well recog-
nized fact that certain fundamental principles
of blood compatibility and clean equipment
must be scrupulously observed to avoid patient
reactions. However, it has been observed that
in certain cases of multiple transfusions here-
tofore unexplained reactions have occurred. It
is now recognized that many of these reac-
tions are due to the Rh factor.
The mechanism of the Rh factor reaction
in transfusion cases is similar to that causing
erythroblastosis foetalis. The recipient of the
transfusion is an Rh negative individual and,
thus, he is responsive to the antigenic stimu-
lation afforded by the donated Rh positive
blood cells. iSince, as previously stated, the Rh
factor is not a powerful antigen, several
transfusions are usually required to produce
enough anti-Rh antibodies to cause a reaction
on subsequent transfusion of the Rh negative
recipient with Rh positive blood. Of course,
it is the donated blood which is hemolyzed
and not that of the recipient, however, the
end result on the recipient is the same as
though his own cells were destroyed. At this
point it is well to warn that the usual meth-
ods -employed for pretransfusion blood
grouping and cross-matching of bloods are
not sufficient safe-guards against the Rh fac-
tor.
If both the recipient and the donor are
Rh positive, no reaction due to the Rh fac-
tor will occur because, according to immuno-
logical fundamentals, an individual will not
produce antibodies against its own tissue. If
both the recipient and the donor are Rh nega-
tive, no reaction due to the Rh factor will oc-
cur because the Rh antigen is not present.
However, if the recipient is Rh negative and
the donor is Rh positive, and several trans-
fusions take place, the recipient may develop
anti-Rh antibodies and react.
In some cases an immediate transfusion
reaction due to the Rh factor or the Hr fac-
tor may occur. There are three mechanisms
for such reactions. First, the recipient may be
&n Rh negative person who has been previously
immunized to the Rh factor by previous trans-
fusions or pregnancies and now receives Rh
positive blood. Since anti-Rh antibodies are
present in the blood of such a recipient, the
donated Rh positive blood precipitates a reac-
tion. Secondly, the recipient may be an Rh
positive person who receives blood from a
previously immunized Rh negative donor.
Since anti-Rh antibodies are present in the
donated blood, they react with the Rh posi-
tive cells of the recipient. Thirdly, the recipi-
ent may be Rh negative and receive blood
from an Rh positive donor whose blood con-
tains anti-Hr antibodies. Such a donor must
be an Rh positive woman who has borne an
erythroblastotic child.
As a preventive measure, the recipient and
donor in a transfusion operation should be
tested for the Rh factor, in addition to the
usual blood grouping and cross-matching
blood test. Also, a carefully taken history on
both the recipient and prospective donor wiil
reveal potential reactions. First, all Rh nega-
tive women who have borne Rh positive chil
dren, especially if there have been abortions,
stillbirths or erythroblastotic infants, should
be eliminated as prospective donors to Rh
positive recipients. Secondly, all Rh negative
persons, regardless of sex, who have been
previously transfused, especially if there is a
history of transfusion reaction, should be e-
liminated as prospective donors to Rh positive
recipients. Thirdly, never knowingly use an Rh
positive person as a blood donor to an Rh
negative recipient. This is necessary to avoid
building up anti-Rh antibodies in the Rh nega-
tive recipient. Fourthly, transfuse like Rh
blood. With the exception of the above contra-
indications, a Rh negative blood may be do-
nated to both Rh positive and Rh negative
recipients. In the case of an emergency, one
may use Group O, Rh negative blood as a
universal donor, if there is any doubt, give
the recipient a preliminary small test dose of
the blood to be donated. A reaction from a
small test dose of blood will warn the sur-
geon of the prospects for a serious reaction if
the transfusion is given.
The Rh Factor in Obstetrics
The Rh factor in obstetrics is related to the
Rh problem of pediatrics and surgery, that is,
it has the same fundamental basis.
Recent attention has been focused upon the
Rh factor as a cause of habitual abortion.
The usual history is that after one or two
normal or only slightly complicated pregnan-
cies, the woman aborts all subsequent preg-
nancies. The abortion occurs after the twelfth
to the twentieth week of pregnancy. The anti-
Rh antibodies usually appear from the
May, 1946
The Rh Factor — -Harrison
645
twelfth to the twentieth week of pregnancy.
The evidence in favor of the Rh factor being
the causative agent is strengthened if the
woman is Rh negative and the husband and
the living children are Rh positive. Of course
the demonstration of the presence of anti-Rh
antibodies in the blood serum of the woman is
confirmatory, but such a test is not easily
performed. So far, there is no remedy for
habitual abortion due to the Rh factor.
Transfusions in a pregnant woman or in
a recently pregnant woman should receive
careful consideration. If there is even the
slightest reason to suspect an Rh factor basis
for the condition necessitating the transfusion,
the case should be carefully studied before
transfusions are employed. If the precautions
stated above for transfusion operations are
observed, serious reactions may be avoided.
The Rh Test
The usual, simplified slide test performance
at room temperature for determining the four
regular blood groups is not applicable to the
Rh factor. Unfortunately, no similar simpli-
fied test has been evolved so far for test-
ing the Rh factor. This, and other inherent
difficulties in the Rh factor test, is inhibiting
its wider clinical application.
In the first place, a universally available,
high potency, anti-Rh testing serum is not at
hand. Artificially prepared rabbit or guinea
pig antisera against rhesus macaeus erythro-
cytes, while theoretically ideal, contains ac-
cessory antibodies which must be removed be-
fore use. So far, the best testing sera are de-
rived from mothers who have recently borne
erythroblastotic children or aborted erythro-
blastotic fetuses. While anti-Rh testing sera
are commercially available, their high cost per
test basis and their uniform potency and speci-
ficity discourages their popular use.
To perform the test for the Rh factor, a
sample of the blood to be tested is mixed
with an anticoagulant and the cells and serum
are separated by centrifuging. The separated
cells are washed three times with physiologi-
cal saline and a one or two per cent cell suspen-
sion in physiological saline is prepared. Next,
the anti-Rh testing serum is diluted to its titer,
as indicated on the label, with physiological
saline. Two drops of the diluted serum and one
drop of cell suspension are added to a 75 mm.
x 7 mm. test tube and after mixing, the tube
is incubated at 37 °C. for one hour. Known
Rh positive and Rh negatives should be tested
simultaneously as controls. At the end of the
incubation period, the tubes are removed from
the water bath and the cell patterns in the
bottoms of the tubes are read with the aid
of a concave mirror, according to the technique
of Landsteiner and Wiener. If no reaction has
taken place, the tubes should be re-incubated
for another hour. The second incubation will
often reveal a positive test for cells previously
read as negative.
REFERENCES
Andujar, John J. Practical Applications of the Rh
Factor to Obstetrics. Texas State Journal of
Medicine , July 1944.
Carter, Bettina B-, M. S. : Loug-hrey, Joseph, M. D.
A Method of Demonstrating Anti-Rh Agglutinins
in Cases of Erythroblastosis Fetalis- American
Journal of Clinical Pathology, Dec- 1945.
Carter, Bettina B-, M. S-: The Production of Rh
Antiserum in Guinea Pig's Through Inoculation
with Ruman Red Blood Cells. American Jour-
nal of Clinical Pathology, July, 1945.
Davidson, I. M.D. Rh Antibodies- American Jour-
nal of Clinical Pathology, March, 1945, Vol. 15,
No- 3.
Haberman, Sol: Hill, J. M- The. Clinical Significance
of the Rh Factor. Its Importance in Erythro-
blastosis Fetalis. Texas State Journal of Medi-
cine, July, 1944-
Hill, Joseph M- and Haberman, Sol. - The Clinical
Significance of the Rh Factor. Its importance
in Transfusion Reactions. Texas State Journal
of Medicine, July, 1944
Levine, Philip, M.D- Isoimmunization by the Rh
Factor — A New Cause of Fetal and Neonatal
Morbidity. Human Fertility, Sept. 1944, Vol. 9,
No. 3-
Moureau, Paul, M.D- Heredity of the Agrglutinogen
Rh. American Journal of Clinical Pathology,
Sept. 1945-
Seldon, Thomas H. : Lundy, John S. : Adams, Charles
R. The Rh Factor. ’
The Lancet, Nov. 4, 1944, Editorial, A Year's Work
on the Rh Factor.
Wiener, Alexander S-, M.D. The Rh Blood Types
and Some of Their Applications. American Jour-
nal of Clinical Pathology, March 1945, Vol. 15,
No. 3.
When a man is no longer anxious to do
better than well, he is done for.
— Benjamin Haydon
Dr. Matas Worctfeb ©utlaw #lazi Physicians
:';r::tr .mi
: b. :j .. : ; ■::: ’• .frs
The following article by Meigs 0< Frost in
the Sunday issue of the deep South’s greatest
daily paper, the Times’ Picayune, will be read
with both interest and profit. Rudolph Matas
typefies the medical spirit of this great South-
ern city. He is a native of Louisiana, but per-
haps the most outstanding medical citizen of
the world. Dr. Matas is so eloquent of tongue,
so kind of heart, so powerful of intellect, so
versatile in education and so profound in wis-
dom that any doctor can ill afford to miss one
word that falls from his lips.
OUTLAW NAZI PHYSICIANS
By Meigs O. Frost
Dr. Rudolph Matas, who has fought disease
for 65 years, starts greatest fight of his career
to purge his profession of Nazis found guilty
of crimes of horror.
A WORLDWIDE WAR to outlaw from their
profession all physicians and surgeons guilty
of the bestial Nazi crime of using human be-
ings for experimental guinea pigs has been de-
clared by Dr. Rudolph Matas, world-honored
New Orleans surgeon.
Thousands of German and other doctors
who teamed with the Nazis through their
years of power, adding unspeakable and ob-
scene chapters to the book of horrors that
ended in World War II, will be barred for
life from the practice of their profession if
Dr. Matas and his associates win the fight
they are launching.
These physicians and surgeons, battling to
purge their profession of its ghastliest prosti-
tution, have the organization that can bring
them victory. It is the International Society
of Surgery, to the English-speaking world;
the Societe Internationale de Chirurgie at its
oldtime headquarters in Brussels, Belgium.
Dr. Matas was its president in 1938, the last
peaceful year before Hitler in 1939 hurled
the armed might of Nazi Germany into Po-
land, and started World War II. The society
normally meets every three years. It never
has met since Dr. Matas delivered his presi-
dential address in Brussels. World War II
made meeting impossible.
The next session of the society is scheduled
for early in 1947 at London, England, under
the auspices of the Royal College of Surgeons
and at the invitation of British surgeons. That
is when the wrath of all decent, ethical phy-
646
- '.Oi'.- ,-x; .a - '■
'Vl' f>‘
sicians and surgeons is scheduled to burst
upon the heads of the Nazi-subservient phy-
sicians and surgeons in Germany and else-
where who followed the beastly Nazi doc-
trines.
“Those physicians and surgeons among the
Nazi followers committed the greatest crime
that can be committed in medicine,” thunders
Dr. Matas. “Nobody can read the authenticat-
ed reports of their callous treatment of human
beings, prisoners of war or enslaved popula-
tions of defeated nations, without horror. De-
liberately they used these human beings as
the subject of experimentation that resulted
in pain and suffering, sickness and death, in
innumerable cases.
“They violated the Hippocratic Oath every
physician must take. They violated the three
great Hippocratic Maxims that are the founda-
tion of the honor of our profession:
“ ‘Sometimes we cure.
“ ‘Sometimes we relieve.
“ ‘Always we comfort.’
“Those damnable Nazi doctrines rotted the
body of the German medical profession to
its heart. Those Nazi-subservient physicians
and surgeons committed crimes against hu-
manity as well as against their own profes-
sion. They utilized patients and prisoners of
war and subject peoples as vile animals. They
tried out on human beings experiments that;
never should be tried on man. Our profes-
sion is ancient and honorable. It must be
purged of beasts such as these.”
Dr. Matas is working day and night at his
home, 2255 St. Charles Avenue, to get that
purge under way. He is acting secretary and
treasurer of the United States National Com-
mittee of the International Society of Surgery
that is working to return the international so-
ciety to its global functions based on its old
headquarters at Brussels, Belgium, as before.
His associates on that committee are such
distinguished American surgeons as Dr. Elliott
C. Cutler, Boston, Mass., chairman; Dr. Eu-
gene H. Pool, New York; Dr. Arthur W. Allen,
Boston. New York headquarters have been
established at the New York Academy of
Medicine building.
“The world’s statesmen are trying to make
the United Nations function,” says Dr. Matas.
“Surgery issues a challenge to statesmanship.
We have made surgery function around the
globe through the International Society of
< May, 1946
Surgery. Look into any operating room, any-
where. Youisee the ^ame white robes, the same
white masks, the same shining instruments.
The color of the skin does not matter there.
All are alike. All are dedicated to the same
high purpose-: to cure, to relieve, to comfort.
That was the ideal of Hippocrates more than
2000 years ago. And that is why men like
these Nazi-dominated surgeons and physicians,
who befoul so great an ideal, must be exiled
from their profession as outlaws by all de-
cent medical men everywhere.”
Dr. Matas has been fighting disease and
death for sixty-five years. But in his sixty-sixth
year he has taken up his greatest fight: to cut
the cancer of Nazi doctrine and Nazi practice
out of the profession to which he has dedicated
his whole life.
Literally he has received every honor the
surgeons of the world could bestow upon him.
Almost daily he ministers to patients who
crowd his office from near and far. In his
eighty-third year he performed a delicate throat
operation other doctors admit “nobody want-
ed to undertake,” and it was successful.
“The Matas Operation,” named for him,
developed by him, is surgery’s classic opera-
tion for aneurisms ; the incredibly delicate
surgery of enlargements of the veins and ar-
teries called “vascular surgery.”
Son of a doctor, he was born September 12,
1860, at Bonnet Carre, La., just above New
Orleans. His early education sounds fantastic:
Paris, France; Barcelona, Spain; Brownsville,
Texas; Matamoros, Mexico; Soule’s College,
New Orleans; Tulane University, Where he
won his M.D. at the age of twenty. He started io
practice as a physician, surgeon, pharmacist,
able fluently to speak, read and write Eng-
lish, French, Spanish and the latter’s Catalan
dialect.
He learned his Latin from an exiled Rus-
sian anti-Czarist prince in Mexico, who “was
intoxicated with the splendors of ancient Ro-
man oratory,” his Greek from a Presbyterian
missionary in Mexico, with whom he read the
New Testament; more Latin from a Catholic
priest in Mexico; his botany in French with
a French textbook from an ex-consul of
France in Mexico ; his physics and zoology in
647
French from French textbooks and a French-
speaking teacher in Mexico; but he enshmnes
the memory of Miss Mary Butler, his tea$hfr
in the public schools of Brownsville, Texasr
The night he won prizes in the humanities,
physics and botany, at graduation exercises,
College of St. John, Matamoros, Mexico, they
were presented by the Mexican general in com-
mand of all military forces there. In the midst
of the ceremonies the audience was electrified
by heavy, continuous bursts of rifle-fire. AH
knew a revolution was about to break. Only
the general knew he had it under control in
Matamoros. He stepped forward and calmed a
crowd about to stampede, with “Don’t worry.
All that shooting is in your honor. Those are
many soldiers firing salutes to celebrate your
great day here at the College of St. John.”
Dr. Matas chuckles at memories like that
one. Memories of his graduation as an M.D. at
Tulane in 1880 bring gentle smiles, too.
“Medical examiners of today don’t know
what happened sixty-five years ago,” he as-
serts. “But we were good at anatomy. I could go
out into the fields and gather medicines. What
we knew made us good general practitioners.
We had our seven branches of medicine from
our Neil & Smith Compend, long since out of
print. It was our ‘multum in parvo,’ our
‘vade mecum.’ I can see yet its pages on
anatomy, physiology, chemistry, modem
medicine, therapeutics, surgery, obstetrics. Neil
& Smith, lectures, clinics, turned out some
fine doctors.
“There are all kinds of doctors. But you’ve
got to love it, to be inquisitive, to observe,
to be worthy of that M.D. And in the whole
history of the world, medicine and surgery-
have made no such progress as they have
made from the time I started to practice up
to now.
“We have defeated disease after disease.
But new diseases are cropping up. There is a
limitation of population for this world, with-
out a doubt. Some disease always comes to
take the place of a disease we have conquered.
The world is always changing.
“But the honor of a physician and surgeon
does not change. And the Nazi-dominated doc-
tors who have befouled it must be outlawed
and exiled.”
Patience is bitter, but its fruit sweet.
-Rousseau
648
Editorials
May, 1946
The Mississippi Doctor
Published monthly at Booneville, Mississippi.
Entered as second-class matter, January 19, 1926,
at the post office at Booneville, Miss., under the Act
of March 3, 1870. Annual subscription $1.00.
The journal with a vision which encourages a plan
of delivering modern medicine to the masses at less
cost to the individual and more profit to the prac-
titioner. It champions the community hospital, the
hub around which this service must be built.
W. H. ANDERSON, M.D Editor-in-Chief
MILDRED P. ANDERSON Assistant Editor
David E. Guyton, Blue Mountain College Poet
C. H. Lutterloh, M. D President
Hot Springs, Ark.
J. C. Pennington, M. D President-Elect
Nashville, Tenn.
L. S. Nease, M. D Vice-President
Newport, Tenn.
John Archer, M. D Vice-President
Greenville, Miss.
John A. Moore, M* D Vice-President
El Dorado, Ark.
A. F. Cooper, M- D Secretary -Treasurer
Memphis, Tenn.
Gilbert J. Levy, M. D Director of Exhibits
Memphis, Tenn.
E. M. Holder, M. D. C. R. Crutchfield, M. D.
F. M. Acree, M. D. H. King Wade, M. D.
Address all material for publication to W. H
Anderson, M-D., Booneville, Mississippi.
Next year the state meeting will be held
in Biloxi on the first Tuesday in May, and it
will be a three-day session as usual.
The recent session of the association was
said to be by old observers the best in spirit
and finest in purpose ever held.
We appreciate our exhibitors. They have the
same purpose to serve as do the doctors.
Everything else being equal, we trust you will
trade with those who come to our meetings
and who advertise in the journal.
The plan is for the Mid-South to open
next February with another good session. This
meeting is very popular with 'the doctors, for
they get a review of medicine and surgery in
four days and nights.
Don’t miss the meeting of the Northeast
Mississippi Medical Society at Booneville on
June 11. Drs. Hollis Johnson of Nashville,
Tenn., and Oscar W. Bethea of New Orleans,
Louisiana, will be the guest speakers. Our
state president, Dr. Avent, of Grenada, will
be with us also.
Read carefully the addresses of President
Crawford and Dr. Percy Wall. They are food
for thought.
The Mississippi State Medical Association
came back this year with renewed determina-
tion for the future. It met at the Robert E.
Lee Hotel in Jackson for a busy two-day ses-
sion, May 14-15. Dr. B. Lampton Crawford of
Tylertown was the able president. Dr. J. K.
Avent of Grenada was installed as president at
the close of the session following the election
of Dr. Paul Gamble of Greenville
as president-elect. The able and faithful Dr.
J. Rice Williams presided as speaker of the
house with his usual efficiency. Dr. M. Y.
Dabney of Birmingham, a native of Missis-
sippi, an outstanding gynecologist, editor of
Southern Medical Journal, and now president
of the Southern Medical Association, delivered
the annual oration on president’s night. Mr.
C. P. Loranz, secretary-manager of the South-
ern Medical Association, visited the association
to announce the meeting of the Southern this
year in Miami, Florida, Nov. 4-8.
The past-presidents of the Central Medical
Society entertained the past-presidents of the
state with a breakfast and a luncheon. Twenty-
four past-presidents were listed by the secre-
tary with nineteen present for breakfast on
Tuesday morning. Dr. W. W. Crawford of
Hattiesburg is the oldest past-president from
the standpoint of service, and his brother,
Lampton, the youngest. The absence of Dr.
G. S. Bryan of Amory who has been ill for
some time was on everyone’s tongue. A tele-
gram was sent to him and flowers also by
wire.
On Tuesday afternoon a dinner was given
to the Half Century Club by Dr. W. H. Ander-
son of Booneville. An honored out-of-town
guest was Dr. Jere Crook of Jackson, Tenn.,
who has been practicing for fifty-two years
but is yet young. It was a joy to have him
present. Dr. W. H. Scudder of Maryville was
the oldest man present, now in his eighty-
fourth year, with a record of continuous prac-
tice for fifty-nine years at the same place. The
picture of the group is elsewhere in the journal.
Dr. W. A. Evans of Aberdeen was elected
leader for the group, with the editor of the
journal as sponsor.
May, 1946
Editorials
649
Recently a friend who lived nearby suf-
fered a ruptured gallbladder while in a city
of an adjoining state. He went to the hospital,
was operated on, and after several stormy
days came through all right. He came in to
be dressed and looked over and remarked that
his hospital and surgeon’s bill was $1100 and
commented on the splendid treatment he
received. We asked him why he did not go to
the Veterans Hospital (he was a World War
I veteran) and he replied: “I did not have
much money, but had rather pay out eleven
hundred as I did than go to a veterans hos-
pital.” It seems that veterans might be al-
lowed to go to the hospital of their choice,
to the doctor of their choice, and be treated
as were the wives of the privates in the army
and let the government pay the bills. Eighty
per cent of the veterans need treatment all
along that could be given by the local doctors.
Letting a veteran use the doctor of his choice
and the home hospital might be the best
plan for the patient, for the doctor and for
Uncle Sam also.
§
Dear Dr. Anderson
I am getting some response to my request
for pictures of doctors in Mississippi, but as
yet no marked enthusiasm has been manifest.
I am making this appeal through the columns
of the Mississippi Doctor , for volunteer help-
ers in this work. Some few doctors have
offered to collect pictures of all doctors in
their respective counties and then to forward
s*me to me at Amory — some few have done
so already. I am appealing, now, for such a
volunteer in EVERY county in the state. This
would not be a difficult task, and I would ap-
preciate it very much. It will save me the
necessity of writing many hundreds of let-
ters. This is a tremendous undertaking, but
it is a labor of love on my part. When this
collection is complete it will be the property
of the State Medical Association and will be
placed on permanent display in the State
Department of Archives and History.
G. S. Bryan
Let every doctor heed the above request
from Dr. G. S. Bryan. Drs. W. A. Evans and
Felix J. Underwood are helping him right
along. Dr. Evans estimates that Dr. Bryan
should have five thousand pictures in his col-
lection within a rather short while if all the
doctors cooperate with him. A good picture
and a brief write-up for every doctor now liv-
ing and for every one who has lived and
served in the state is the goal. This hobby
has a distinct value. It is also a fine labor
of love on the part of Doctor Bryan. Let
us heed the request of this beloved member
of the Half Century Club, who is no longer
able to attend the state meetings.
§
APPRECIATION
I know of no channel, other than Mississip-
pi Doctor , through which I can express my
appreciation of the beautiful flowers sent me
— and the friendship and love that prompted
the sending — by the members of the Past-
President’s Club. There are no words that can
adequately express my love for the members
of this club, both individually and collectively.
How I wish that I might look into the eyes of
each member, for when “eyes speak love to
eyes that answer back” there is no need for
spoken words.
I also wish to acknowledge the receipt of
telegrams from the full membership of the
Association as well as one from the Half
Century Club, and to thank them from the
depths of my heart for the sentiments con-
veyed by these telegrams.
May God bless and prosper every one of
you is my sincere wish and earnest prayer.
I am yours sincerely as long as life may
last,
G. iS. Bryan.
WAR RELIEF APPEAL
In Yugoslavia 1,487,000 children are in
desperate need of medical care, 150,000
known victims of tuberculosis, 1,000,000 per-
sons infected with malaria. In Macedonia half
the population has malaria. In Yugoslavia as
a whole one out of 25 has tuberculosis and
the death rate from tuberculosis is ten times
higher than in the United States. In pre-war
Yugoslavia, the infant mortality rate was the
highest in Europe, with 155 dead for every
thousand living births as compared with 56
in the United States. Now the infant mortality
rate has risen to 170 dead out of every
thousand living births, while in Greater New
York, infant mortality has decreased to 35
per thousand births, in Sweden to 30, in Eng-
land, to 38.
In all of Yugoslavia there are but 12,000
May, 1946
650 News and Comment
hospital beds. For the 150,000 people with
active tuberculosis who require hospitalization,
there are only 1,500 beds. In mountainous
Yugoslavia with its shattered communications
there is but one doctor to every 5,000 people
and in isolated communities it is nearer to one
doctor to every 10,000. Greater New York has
one physician to 450 persons. Tuberculosis-
ridden Yugoslavia has but two chest surgeons.
These are the figures.
The American Committee for Yugoslav Re-
lief, 235 East 11th Street, New York City, is
conducting a campaign for $5,000,000 to pro-
vide some part of these medical necessities.
News and Comment
DR. GAMBLE TO HEAD MEDICAL
ASSOCIATION
Dr. Paul Gamble, Greenville, took office as
president-elect of the Mississippi State Medi-
cal Association following his election at the
May 15 session.
Dr. J. K. Avent, Grenada, was inducted as
president, having served the past year as
president-elect.
Other officers elected included Dr. C. H.
Crawford, Tylertown, retiring president, as
vice-president for the Southern District; Dr.
H. F. Garrison Jr., Jackson, vice president,
Central District, and Dr. E. A. Brown, Water
Valley, vice president, Northern District. Dr.
J. G. Thompson, Jackson, was named historian,
and Dr. W. H. Anderson, Booneville, editor.
Associate editors are Dr. L. L. McDougal Jr.,
Tupelo, and Dr. Stanley A. Hill, Corinth.
Dr. J. Rice Williams, Houston, was elected
speaker of the House of Delegates; Dr. E.
Leroy Wilkins, Clarksdale, treasurer, and Dr.
T. M. Dye, Clarksdale, secretary.
Council members remain the same.
Delegates to the American Medical Asso-
ciation are Dr. Felix J. Underwood, state
health officer, and Dr. J. P. Wall, Jackson.
A resolution adopted by the association de-
plored asserted “politics in certain state hos-
pitals and institutions,” and a committee of
three authorized to investigate the charges. No
institutional needs were mentioned in the reso-
lution.
THE FOLLOWING PHYSICIANS HAVE
RETURNED FROM MILITARY SERVICE
The following physicians have returned to
Mississippi from military service:
Dr. W. O. Biggs, Osyka; Dr. Paul B. Brum-
by, Lexington; Dr. E. A. Bush, Laurel; Dr.
Isaac Coe, Clarksdale; Dr. W. D. Fitzgerald,
Ruleville; Dr. Gerard J. Frederic, Pascagoula;
Dr. Harry G. Fridge, Richton; Dr. Raymond
Frederic Grenfell, Jackson; Dr. C. H. Hey-
wood, Canton; Dr. W. A. Hull, Indianola; Dr.
R. D. Kirk, Jr., Tupelo; Dr. James F. Lewis,
Columbus; Dr. J. F. McDonough, Pascagoula;
Dr. E. M. Meek, Greenwood; Dr. T. S. Robert-
son, Jackson; Dr. B. L. Robinson, Meridian;
Dr. R. E. Shands, New Albany; Dr. V. L. Ter-
rell, Columbia.
Dr. T. J. Barkley, Belzoni; Dr. S. H. Bar-
ron, Columbia; Dr. R. E. Cunningham, Jr.,
Florence; Dr. L. M. Ferris, Vicksburg; Dr.
G. S. Hicks, Natchez; Dr. J. B. Howell, Jr.,
Canton; Dr. A. T. Nadeau, Jr., Grenada; Dr.
E. E. Sheely, Gulfport.
PIKE COUNTY MEDICAL SOCIETY MEETS
IN McCOMB
The Pike County Medical Society held its
regular bi-monthly meeting on Thursday, May
2 at the McColgan Hotel in McComb. Follow-
ing a delicious chicken dinner members and
the business and educational portion of the
guests adjourned to an upstairs lounge where
the program was conducted.
Dr. L. W. Brock, president, of McComb pre-
sided over the meeting. At the termination of
a short business session the guest speaker,
Dr. J. O. Weilbacker, assistant professor of
medicine, Louisiana State University Medical
School, New Orleans, Louisiana, and chairman
of the medical division, New Orleans Medical
Foundation, was presented to the audience by
Dr. A. V. Beacham of Magnolia, Mississippi.
A most interesting and informative lecture
on “The Management of Diabetes Mellitus”
was presented to the group by Dr. Weilbacker.
The following members and guests were
present: The guest speaker, Dr. J. O. Weil-
backer of New Orleans, La.; Dr. J. J. Pitt-
man and A. B. Harvey of Tylertown, Miss.;
M. B. Small and M. L. Pittman of Kentwood,
La.; H. C. Denson and W. M. Biggs of Osyka,
Miss.; A. V. Beacham and G. W. Robertson
of Magnolia, Miss.; F. S. Herrin and J. E.
May, 1946
News and Comment
651
Hewitt of Summit, Miss.; L. W. Brock, R. H.
Brumfield, E. M. Givens, T. L. Moore, Jr., Abe
Mickal, F. L. Butler, S. Paul Klotz, Thomas
Purser, Sr., Thomas Purser, Jr., L. L. Bauer,
W. F. Cotten, W. C. Hart, Gladys Ratcliff, and
B. J. Hewitt of McComb, Miss.
ANNOUNCEMENTS
The staff of the Street Clinic and Mercy
Hospital-Street Memorial announces the return
from military service of Lucian Minor Ferris,
M. D., practice devoted to internal medicine.
Dr. William T. Howard announces the open-
ing of his offices, practice limited to orthopedic
surgery, 801 Medical Arts Building, Memphis,
Tennessee.
Dr. Horton G. DuBard having recently re-
turned from military service announces the
opening of offices, suite 426, Physicians and
Surgeons Building, 899 Madison Avenue, Mem-
phis, Tenn.
Dr. John Henry Lotz announces the re-open-
ing of his office for the practice of dermatology
and syphilology, 1098 Madison Avenue, Mem-
phis, Tennessee.
Dr. Buford Word wishes to announce his
return from active duty with the armed forces
to resume his practice in gynecology and
obstetrics at 900 South Twentieth Street,
Birmingham, Alabama.
The Vicksburg Hospital, Inc., and the Vicks-
burg Clinic announce the association of James
A. Kiely, M. D., pediatrician, and Joseph M.
Moore, M. D., orthopedic surgeon.
The Vicksburg Hospital, Inc., and the Vicks-
burg Clinic announce the return from military
service of James L. Hall, M. D., practice
limited to dermatology and syphilology.
The staff of the Street Clinic and Mercy
Hospital -Street Memorial announces the as-
sociation of Donald Tasker Imrie, M. D., ortho-
pedic surgeon.
John Bond Nuckolls, M. D., announces his
return to the civilian practice of urology. Ad-
dress: 424 East Main Street, Jackson, Tenn.
John Lyle Shaw, M. D., announces the re-
opening of his office for the practice of
urology, and urological surgery, suite 507,
Medical Arts Building, Memphis, Tennessee.
Dr. James B. McLester announces his re-
turn from military service and resumption
of practice in association with Dr. James S.
McLester, 930 South Twentieth Street, Birm-
ingham, Alabama.
Carl D. Marsh, M.D., F.A.C.A., announces
the opening of his office for the practice of
allergy and dermatology, 616 Goodwyn Insti-
tute Building, Third and Madison, Memphis,
Tennessee.
Campbell Clinic announces the return from
military service of Lt. Col. Hugh Smith and
Col. Thomas L. Waring, 869 Madison Avenue,
Memphis 3, Tennessee.
Dr. A. V. Beaeham of New Orleans, La., has
recently been elected to the executive commit-
tee of the Southeastern Branch of the Ameri-
can Urological Association. The meeting was
held in Augusta, Ga.
Dr. W. D. Beaeham, also of New Orleans,
was elected to membership to the Louisiana
Alpha Chapter of the Alpha Omega Alpha
Medical Honor Society this spring. This is the
first time that the Tulane Chapter has elected
a transfer.
SHARP & DOHME ANNOUNCE $1,800
RESEARCH GRANT
The Department of Animal Husbandry
Pennsylvania State College, is the recipient
of an $1,800 research grant from Sharp &
Dohme, Philadelphia, it was announced last
month.
The grant is a renewal of previous grants
and affords increased financial support to a
research program under the direction of Dr.
W. T. jS. Thorp, Professor of Animal Pathology.
Dr. Thorp is making an extensive study of
various sulfonamides in the treatment of
infectious and parasitic diseases in livestock
and poultry.
MEDICAL EDUCATION BOARD MEETING
The State Medical Education Board, created
by the 1946 legislature, met May 29 at the
652
News and Comment
May, 1946
Executive Mansion on call of Governor Bailey,
who opened the session and turned over the
meeting to Dr. D. S. Pankratz, acting dean,
Medical School, University of Mississippi. Dr.
Pankratz, by virtue of his office, serves as
chairman of the new board, which will ad-
minister a fund of $325,000 for awarding of
scholarships in medical education to worthy
and qualified Mississippi students. Legislation
establishing this program was authored by
Hon. Walter Sillers, Bolivar County.
Meeting for purposes of organization and
policy planning, tne'mbefs of the board dis-
cussed legislation creating the scholarship fund
and took steps in setting up offices and defi-
nite procedures. Dr. Felix J. Underwood,
director, Mississippi Sthte Board of Health,
was elected as vice-chairman of the board.
Working office will be located at Jackson and
offices maintained at the University.
Mrs. H. H. Ellis, past president, Mississippi
Federation of Women’s Clubs, Meridian, and
Dr. J. K. Avent, president, Mississippi State
Medical Association, Grenada, were active par-
ticipants in laying the groundwork for the
new board’s program. W. H. Braden, superin-
tendent of schools, Natchez, was detained from
the meeting by illness.
Mrs. Maria Voscamp, Jackson, was named
secretary of the board.
FIRST ANNUAL MEETING — BOARD OF
DIRECTORS, MISSISSIPPI DIVISION, THE
AMERICAN CANCER SOCIETY
On Monday evening, May 13, at 7 :30 p. m.
sixteen members of the Board of Directors
of the Mississippi Division of the American
Cancer Society attended the first annual meet-
ing held at the Heidelberg Hotel, Jackson.
The State Campaign Chairman, Dr. Felix
J. Underwood, gave a report of the 1946 Fund-
Raising Campaign indicating that twenty-six
of the fifty-two counties organized for the
campaign had reported over $40,000 of the
$66,000 goal raised. In commenting upon the
campaign Doctor Underwood stated that there
had never been such public response to an
appeal for funds for cancer. He stated fur-
ther that the willingness of organizations and
individuals to cooperate had been gratifying
and showed a public awareness of the needs
of the people.
Acknowledgment was made of the coopera-
tion of the State Commander, Mrs. Elizabeth
Wates, and also the Regional Commander,
Mrs. .H. B. Ritchie of Athens, Georgia, and
also the district commanders, the local cam-
paign chairmen and chairmen of the local
units.
Governor Thomas L. Bailey served as honor-
ary state campaign chairman for the second
year and showed great interest in the cam-
paign by issuing a proclamation and other-
wise bringing the need for the program to
the attention of the citizens of the state, it
was stated. . .
Campaign results other than financial point-
ed out by Doctor Underwood were listed as
follows ;t, , . s
Ma,ss, education in cancer control through
all . means of transmission of information
Bringing to light cases not known to exist
before
Evidence of . an appreciation upon the part
of the public of the program and the
field for service and a broadening of the
base of public interest as shown by the
increase in the number of contributions
Fact that all citizens are beginning to con-
sider local facilities for the diagnosis and
treatment of cancer
Realization that progress made is ground
definitely gained and all organizational
procedures because of the complete execu-
tion will leave a base for campaigns of
the future
The reaching of a definite goal has lent
unity of purpose and communities are
working together to solve their problems
by individual and collective efforts
The enthusiastic response has shown a
recognition of needs and an effort to
provide cancer funds for solving the prob-
lem for at least one year
Cancer has been presented to the public
as a health problem dependent upon an
enlightened public for solution.
Mrs. Elizabeth N. Wates, state commander,
gave a splendid report showing accomplish-
ments. She stated that 125 cases had received
treatment since November 1 of last year.
District commanders’ reports made showed
encouraging progress and increased awareness
of the cancer situation in Mississippi. District
commanders reporting were:
Dr. Emma Gay, Biloxi
Dr. Barbara Hunt, Houston.
The report of Mrs. E. E. Herrington of
Amory was read.
May, 1946
News and Comment
653
Complete By-Laws of the Division were
drawn up and adopted.
The report of the treasurer, Mr. George
C. Wallis, was read in his absence by Mrs.
Ethel Fulgham and it showed that funds in
the treasury were being depleted rapidly in
the care of cases. The funds for the 1946
campaign will be greatly needed to show a
balance in hand.
Present at the meetings were : Dr. A. L.
Gray, director, Division of Preventable Disease
Control, State Board of Health, Dr. A. J. Mc-
Ilwain, Jackson, Dr. F. L. Bratley, Jackson,
Dr. W. H. Anderson, Booneville, Dr. Felix J.
Underwood, Jackson, Dr. Harris Bell, Vicks-
burg, Dr. R. H. Fenstermacher, Vicksburg, Dr.
W. H. Parsons, Vicksburg, Dr. Robert H.
Moore, Vicksburg, Dr. J. K. Avent, Grenada,
Dr. K. O. Stingily, Meridian, Dr. W. H. Bran-
don, Clarksdale, Dr. Emma Gay, Biloxi, Dr.
Barbara Hunt, Houston, Mrs. J. I. Wates and
Mrs. Ethel Fulgham.
HOSPITAL SERVICE IN THE UNITED
STATES
The annual hospital report of the Council
an Medical Education and Hospitals published
in this issue of The Journal shows a continued
increase of hospital service in 1945. The num-
ber of patients admitted was 16,257,402 or
220,544 more than reported in 1944. In addi-
tion there were 1,969,667 hospital births, a
total unequaled in any previous year. The
tremendous volume of hospital service in the
United States is likewise reflected in the aver-
age census, or daily patient load, which reach-
ed a new high of 1,405,247. This average,
measured over a period of one year, represents
the unprecedented total of 512,915,155 treat-
ment days. Included in the survey of 1945
are 6.511 registered hospitals, which have a
combined capacity of 1,738,944 beds exclusive
of 81,131 bassinets. While the number of beds
represents a gain of 8,999 in the last year, the
increase is small when compared with the
rapid wartime expansion of 265,427 beds in
1943 and 80,691 in 1944.
The present report reflects only the early
phase of peacetime readjustments in the hos-
pital field. Changes are noted particularly in
the federal hospitals, which show a reduction
in number, in bed capacity and in total patients
admitted. The later were reduced by 239,322
in 1945, whereas an increase of 254,664 was
reported in the previous year. Longer periods
of hospitalization are now evident in the fed-
eral classification as well as an increased
census, or daily patient load. The percentage
bed occupancy increased sharply in 1945, as
did also the average length of stay in the
federal general hospital group. As in the pre-
vious war years, the statistical data on federal
hospitals have been compiled as a unit re-
port. It is not possible, therefore, in- the pres-
ent survey to supply separate information on
federal groups except so far as individual
hospital data are included in the registered
list.
The general hospitals supply the greatest
volume of hospital service, as evidenced by
their report of 15,228,270 admissions, or 93.6
per cent of all patients admitted in 1945. They
likewise gave care to 1,907,772 newborn in-
fants, 96.8 per cent of the total live births
in hospitals registered by the American Medi-
cal Association. Increases in general hospital
admissions occurred in all governmental and
nongovernmental groups except in the federal
classification and in the hospitals listed as
corporations unrestricted as to province. The
governmental general hospitals received 38
per cent of the total admissions, the non-
governmental general hospitals 57.6 per cent.
In 1945 the average length of stay in general
hospitals increased by two days, while the bed
occupancy rate advanced from 61.6 to 72
per cent. These changes are largely the result
of corresponding developments in the federal
hospital group. In previous years the average
census of the mental institutions exceeded the
daily patient load reported by general hos-
pitals. For the first time this trend has now
been reserved, with a reported average of
665,105 in the general hospitals as compared
with 624,349 in the mental hospital group.
Considering the supply and utili-
zation of hospital beds, it is of interest to
note that the nonfederal general hospitals in
relation to the estimated civilian population
(U. S. Census Bureau, July 1, 1945) show
a ratio of 3.5 beds per thousand, with an ac-
tual daily utilization of 2.6.
The governmental hospital group, which in-
cludes federal, state, county, municipal and
city-county hospitals, has 78 per cent of the
total hospital beds. They however received
only 39 per cent of the admissions in 1945,
whereas the nongovernmental hospitals, with
654
News and Comment
May, 1946
22 per cent of the beds, admitted nearly ten
million patients, or 61 per cent.
Included in the present survey are reports
on nursing personnel and schools of nursing
education accredited by the respective states.
Training is offered in 1,250 accredited schools,
which report an enrolment of 130,909 student
nurses as compared with 129,879 in 1944. One
hundred and seventh-one schools, offering
only affiliating courses, accommodated 11,233
student nurses in 1945. In the registered hos-
pitals approximately 145,000 graduate nursrs
are regularly employed. The report shows an
increase in all classifications of professional
nursing personnel and also an expansion in
the auxiliary nursing groups except in relation
to practical nurses and attendants.
Hospitals are primarily concerned with the
care and welfare of the sick, but many have
also undertaken the additional responsibility
of training interns, resident physicians, nurses
and technical personnel. These educational
functions do not in any way conflict with
the chief purpose for which the hospital is
maintained but serve to enhance the quality of
medical and hospital care. The hospitals of
the United (States have completed the war
years with a high record of achievement. Their
accomplishment, in the face of many difficul-
ties, gives full assurance that they will con-
tinue to render faithful and efficient service
in the years to come.
— Journal of American Medical
Association
A politician thinks of fthe next election;
a statesman of the next generation.
— James Freeman Clarke
Book Review
SYNOPSIS OF PHYSIOLOGY , by Rolland J. Main,
Ph. D.( published by the C. V. Mosby Company, St.
Louis, Mo. Illustrated, 341 pp. Price $3-50.
This is a valuable book for the library of
any doctor. Dr. Main is professor of physiology
in the Medical College of Virginia. The purpose
of the book is to furnish the essentials in
physiology as a review for the doctor. The
book is divided into nine chapters. The first
and a most interesting chapter is on proto-
plasm and the cell. Environmental adaptation
of cells and hemostasis is given due considera-
tion in a second chapter. The discussion of
the circulation and respiration are most in-
teresting and helpful to one interested in the
automatic intricacies of the human body. The
physiology of digestion is stimulating, in view
of so many people beng affected with gastric
and duodenal ulcers. Dr. Main’s treatise on
physiology of endocrines and reproduction and
shock is very helpful as well as the review of
special organs of the body as the eye, ear,
kidney, and liver. Aviation physiology also
constitutes an interesting discussion.
REFLECTIONS
Looking back on the short span of years
I have lived, and thinking in retrospect of
my associations with men, I am wondering
if we do not wear ourselves out making money
and spending it, putting our hearts into sordid
affairs to such an extent that we have no
time to see the simple beauties of nature
or to appreciate the worth of abiding values.
I am wondering if we should revert to pa-
gan simplicity we should not be more able
to catch a glimpse of Proteus, rising from
the sea, and in that glimpse get a more glori-
ous vision of the eternal fitness of things,
than when we visit the gilded palaces or view
the glittering excesses of civilized society ram-
pant.
I am wondering if civilization is possibly
traveling with no particular destination. I
simply wonder, don’t you?
Why should I bum my heart out in an
inane desire to be a Henry Ford, or an An-
drew Mellon, or even one less celebrated, when
I have not the capacity to begin to appreciate
the significance of their position or responsi-
bility. I could easily imagine in my more sane
moments that men like Henry Ford might
get greater enjoyment from helping men in
the pursuit of the fuller life, rather than
in acquiring material possessions.
( Contributed by Dr. J. A. Rayburn, Pontotoc,
Miss.)
He who endeavors to control the mind by
force is a tyrant, and he who submits is a
slave.
Ill habits gather by unseen degrees,
As brooks make rivers, rivers run to seas.
— Dryden
655
May, 1946.
News and Comment
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OFFICERS 1946-1947
PRESIDENT
J. K. Avent Grenada
PRESIDENT-ELECT
Paul Gamble Greenville
VICE-PRESIDENTS
E. H. Crawford : . Tylertown
H. F. Garrison — Jackson
E. A. Brown Water Valley
HISTORIAN
j. G. Thompson.... Jackson
EDITOR
W. H. Anderson Booneville
ASSOCIATE EDITORS
Stanley A. Hill Corinth
L. L. McDougal, Jr Tupelo
SPEAKER OF THE HOUSE
J. Rice Williams Houston
TREASURER
Sixth District
Lamar Arrington Meridian
Clark , Kemper , Lauderdale, Newton, Neshoba,
Winston
Seventh District
T. E. Ross Hattiesburg
Covington, Forrest, George, Green, Jasper,
Jefferson Davis, Jones, Lamar, Marion,
Pearl River, Perry, Wayne
Eighth District
W. H. Frizell Brookhaven
Adams, Amite, Copiah, Franklin, Jefferson,
Lawrence, Lincoln, Pike Walthall,
Wilkinson
Ninth District
D. J. Williams Gulfport
Hancock, Harrison, Jackson, Stone
COMMITTEES
PROGRAM
E. Leroy Wilkins Clarksdale
SECRETARY
T. M. Dye Clarksdale
COUNCIL
First District
J. W. Lucas Moorhead
Bolivar, Coahoma, Humphreys, LeFlore, Quit-
man, Sunflower, Tallahatchie, Tunica,
Washington
Second District
L. L. Minor Route 4, Memphis, Temn.
Benton, DeSoto, Lafayette, Marshall, Panola,
Tate, Tippah, Union, Yalobusha
Third District
R. B. Caldwell Baldwyn
Alcorn, Calhoun, Chickasaw, Clay, Itawamba,
Lee, Lowndes, Monroe, Noxubee , Oktibbeha
Pontotoc , Prentiss, Tishomingo
Fourth District
W. H. Curry Eupora
Attala, Carroll, Choctaw, Grenada, Holmes
Montgomery, Webster
Fifth District
THE SECRETARY
chairmen of sections
CONSTITUTION AND BY-LAWS
V. H. Frizell (One Year) Brookhaven
V. W. Crawford ( Two Years ) .— Hattiesburg
). W. Jones (Three Years ) Jackson
W. H. Anderson ( One Year) .... Booneville
Gus Street i (Two years) Vicksburg
Henry Boswell (Three Years) .... Sanatorium
publication
W. H. Anderson
Stanley A. Hill
L. L. McDougal, Jr
budget and finance
B. B. O’Mara (One Year)
Edgar Giles (Two Years)
L. V. Rush (Three Years)
exhibits
George Riley (One Year)
C. H. McCall (Two Years)
B. B. O’Mara
A. M. A. DELEGATE
Booneville
.... Corinth
Tupelo
Biloxi
..... Avalon
Meridian
Jackson
Gulfport
... Biloxi
F. J. Underwood (One Year) Jackson
J. P. Wall (Two Years) Jackson
FRATERNAL DELEGATES
H. C. Ricks Jackson
Claiborne, Hinds , Issaquena, Leake, Madison,
Rankin, Scott, Sharkey, Simpson, Smith,
Warren, Yazoo
H. Lowry Rush (Alabama) Meridian
F. M. Acree (Arkansas) Greenville
W. H. Anderson (Tennessee) Booneville
C. H. McCall (Louisiana) Gulfport
Staff of Review
Dermatology — James G. Thompson, Jackson.
Ear, Nose and Throat — Edley Jones, Vicks-
burg.
Obstetrics and Gynecology — J. F. Lucas,
Greenwood.
Orthopedics — Thomas H. Blake, Jackson.
Public Health — Felix J. Underwood, Jackson.
Pediatrics — Harvey F. Garrison, Jackson.
Radiology and Roentgenology — Karl O. Stin-
gily, Meridian.
Pathology — R. M. Moore, Vicksburg, Miss.
Surgery — W. H. Parsons, Vicksburg.
Urology — Temple Ainsworth, Jackson.
DERMATOLOGY
Volume 53 Number 1
January 1946
Page No. 45 and 46
Dermatological Problems in Tropical
Theatres. Editorial, Bull. U. S. Army M. Bull.
4:299 (Sept.) 1945.
This article briefly outlines the salient
features of experience accumulated during this
war and does not discuss the exotic tropi-
cal dermatoses. The following dermatolog-
ic diseases have been outstanding: (1) ecze-
matoid dermatitis with secondary pyogenic
infection; (2) the atypical lichen planus syn-
drome characterized by a combination of
eczematous plaques and hypertrophic violace-
ous lichenoid lesions; (3) bullous impetigo;
(4) ulcerative pyogenic lesions; (5) super-
ficial fungous infections; (6) contact derma-
titis due to the sap of various trees; (7)
cutaneous diphtheria; (8) malaria; (9) furun-
culosis, and (10) acne vulgaris, seborrheic
dermatitis, psoriasis, atopic dermatitis, and all
forms of localized eczema, which tend to be-
come worse in hot humid climates.
The following general principles of derma-
tologic diagnosis and treatment were found to
be important in the tropics:
1. Overtreatment with irritating and sensi-
tizing drugs causes more disability than the
primary diseases. In particular, tincture of
iodine, Fraser’s solution (salicylic acid, ben-
zoic acid, tincture of iodine and spirits of
camphor), sulfonamide ointments, strong sali-
edical Literature
cylic acid preparations and ointment of ben-
zoic and salicylic acid or any medication which
causes even a questionable exacberation
should be discontinued immediately.
2. The pyogenic dermatoses are important
causes of prolonged disability, especially if
they are neglected and become well establish-
ed. Sulfonamide ointments should not be used.
3. Patients with eczematoid lesions partic-
ularly on hands, feet and groin, cannot be
treated on an ambulatory basis.
4. Therapeutic agents such as sulfonamide
compounds, arsenicals, quinacrine hydro-
chloride and quinine should be withheld or
given with caution to patients with cutaneous
diseases which might be caused by sensitiza-
tion to drugs.
5. So far as possible, ulcerative lesions
should be considered on an etiologic basis.
6. Heavy ointments and pastes, occlusive
dressings and preparations containing more
than 3 per cent salicylic acid are not well
tolerated in the tropics.
7. The etiologic role of fungi should not
be over-emphasized, because it leads to failure
to consider other etiologic factors, such as
pyogens, contacts, psychosomatic factors,
and other endogenous drug and food allergens.
Strakosch, Denver.
Observations On Scabies at the St.
Pancras Bathing Center. M. G. Geffen, Brit.
M. J. 2:825 (Dec. 23) 1944.
During 1943 the author treated 1,136 school
children with new cases of scabies, 201 chil-
dren of preschool age and 442 adults by having
benzyl benzoate painted on by a trained per-
sonnel at a clinic. Seventeen per cent of the
school children returned to the clinic with
recurrences. Among the adults and younger
children 8 per cent returned with active
scabies.
Investigation of the fifty-two recurrences in
the latter group revealed that twenty-two oc-
curred in families in which some contact had
not been treated; ten more patients knew that
they had been in contact with scabies outside
their homes while the twenty remaining could
give no information revealing any source of
reinfection.
658
Interpreting Medical Literature
May, 1946
Owing to a failure in the boiler system it
was found impossible to give the usual pre-
liminary bath to the school children attending
for treatment. It was interesting to observe
that there was no falling off in the cures dur-
ing or soon after this period.
Scrubbing the skin to open burrows and
lesions has been abandoned, the only apparent
differences being that children with secondary
sores no longer suffer as they did under this
infliction. Children under twelve months of
age were treated with “Marcussen’s ointment.’’
Experience has shown that recurrent scabies
is a disease caused by dirt and that treatment
at home frequently fails.
PEDIATRICS
Penicillin therapy in rat bite fever
Brooksaler, Fred - Journal of Pediatrics
27: 442 (November) 1945.
It is now fairly well established that fever
following rat bite may be caused by either
of the two etiologic agents: 1) sodoku,
the spirillar form, or 2) the strepto-
bacillary form caused by iStreptobacillus moni-
liformis (Haverhillia multiformis or Strepto-
thrix muris ratti).
“Sodoku, the endemic, Japanese or Oriental
form, is produced only by the bite of a rat or
other animal. On the other hand, S. monili-
formis septicemia is caused by a rat bite but
also follows the ingestion of contaminated
food. The latter disease has been called Haver-
hill fever.
.“The clinical picture of rat bite fever, due
to the Spirillum minus (sodoku), is as fol-
lows: After an incubation period of about one
to three weeks there is an exacerbation of the
original wound with development of local
swelling, pain, and purplish-red discoloration.
A chancre-like ulcer develops. Regional
lymphangitis and lymphadenitis are present.
There is frequently a macular or a papular cu-
taneous rash which may ibe generalized but is
• often restricted to the area about the wound.
The fever is of a remittent or intermittent type,
and there may occur afebrile periods of three
to nine days followed by another cycle of
pyrexia. Arthritis is usually absent. The
laboratory findings are polymorphonuclear
leucocytosis, a secondary anemia, a usually
negative blood Wassermann but a frequently
positive Kahn reaction. Arsenicals in their
various forms have been the treatment of
choice for sodoku. The therapeutic dose is
identical with that commonly employed in
antisyphilitic treatments. The response is very
good with abrupt cessation of fever and
symptoms.
“On the other hand, rat bite fever due to
S. moniliformis is characterized by a short in-
cubation period of about three to six days.
Ordinarily the patient has chills and fever,
vomiting and headache. There is an early
fine maculopapular morbilliform or petechial
rash. Arthritis is typically present, frequently
multiple and with no definite joint predilec-
tion. The fever may be relapsing or remit-
tent or septic in type. The serologic tests for
syphilis as a rule are negative. The white cell
count is usually elevated. For definite diagno-
sis of the disease, the S. moniliformis has
to be isolated from blood or joint fluid ... So
far as the treatment is concerned, there is no
response to arsenicals, and the use of sulfona-
mides has been disappointing.
“The writer had the opportunity of observ-
ing a case of rat bite fever due to S. monili-
formis in an 18-month-old girl. This child was
treated with penicillin, and the therapeutic
response to this treatment was prompt and
permanent.
“Case Report. - S. N., a white girl aged 18
months, was admitted to Bradford Memorial
Hospital on September 28, 1944, with a history
of having been bitten by a rat on one toe six
days previously. Within three days she de-
veloped high fever (103 to 104° F.) with a
chill and a rash on arms and face similar to
measles. The site of the rat bite became smal-
ler and purplish discoloration spread up the
foot. The patient was put on sulfonamides for
two days without effect. Anti-pyretics were
used, and the temperature returned to nor-
mal for one day. Then the mother noticed
pain in the child’s shoulder when she was
lifted. Because of the return of fever, the per-
sistence of the rash, and the development of
increased somnolence, the patient was sent to
Bradford Hospital.
“At the time of admission the child was
acutely ill and her temperature was 104.8° F.
b> rectum. There was a macular pink rash
distributed generally over her body covering
the extremities including the palms of her
hands and the soles of the feet, less prominent
on the chest, abdomen, and back. On the right
second toe there was a ragged, secondarily
infected laceration with moderate edema . . .
The liver was palpable 1 cm. and the spleen
3 cm. below the costal margin.
659
May, 1946
Sta'te Board of Health
“The white blood cell count Was 14,650 per
cu. mm. with 73 per cent polymorphonuclears
and 26 per cent lymphocytes. The Kline test,
the urinalysis, and the agglutination tests for
typhoid, paratyphoid A and B, Bacillus abor-
tus and Bacillus proteus X19 were all negative.
The darkfield examination failed to reveal
spirochetes. The first blood culture was also
negative.
“The patient was treated symptomatically
for the fever which was of a septic type unth
on the fourth hospital day in another blood
culture gram-negative pleomorphic rods were
found which, because of the morphologic and
growth characteristics, were identified as
Haverhillia multiformis.
“Immediately after the diagnosis was estab-
lished, penicillin treatment was started with
5,000 units intramuscularly every three
hours. On the next day the temperature drop-'1
ped to normal and remained normal until
discharge. The rash disappeared, and the
wound on the" toe healed within the fallowing
four days.
All blood cultures after the start of penicil-
lin treatment were negative. The child suf-
fered no relapse and was discharged in good
condition on the eleventh hospital day after
a total of 225,000 units of penicillin had been
given. Follow-up observations have shown
that she has had no recurrence.
“Penicillin is recommended as the treatment
of choice in rat bite and Haverhill fevers.”
COMMENT
It has never been our experience to have
treated any child with this condition with
penicillin, but we feel that the experience of
the author is sufficient to justify the use of
this most excellent therapeutic remedy for this
condition in the manner ihdicated by the au-
thor.
State Board of Health
Fel ix J- Underwood, M .D.
CHILD GUIDANCE IN MISSISSIPPI
By Estelle A. Magiera, M. D.
In January, 1945, the periodical, Understand-
ing the Child *, (published an account of the first
year’s work of the Child Guidance Centers in
Mississippi. Begun September 1, 1943, and
modeled after the famed Judge Baker Guid-
ance Center, the Centers were established as a
part of the public health program to help in
the prevention of emotional and social illness.
A good start was made and there has been
steady progress in spite of innumerable dif-
ficulties. A current report prepared for the
State Board of Health meeting, June 17-19,
portrays some of the activities of this Division
during its second year.
By having the principal clinic in Jackson
and five mobile clinics, it has been possible to
extend the services of the Child Guidance
Division of the state as a whole. Referrals
come from the schools, social agencies, parents,
(* - Understanding the child , VoK 14; 12-18, Jan.,
1945) . ;y.~. ;
physicians and county health department per-
sonnel, with the majority being referred by
the schools. Physicians have been the second
source of referrals. Satisfied parents who have
availed themselves of the service have re-
ferred their friends. Each child coming to the
clinic must have a complete physical and
neurological examination by a physician so
that it can be determined in advance that
the problem is of psychogenic origin and amen-
able to correction through the Child Guidance
facilities. On the initial interview a child is
usually given a psychological examination and
referral data is taken by the psychiatric social
worker. After this has been completed the
psychiatrist sees the child, usually on weekly
appointments, until the problem of which it
was referred is no longer a significant issue
and the child has better understanding of his
own behavior. . .. yr..
The-'- work done by the staff in rtfie mobile k'
clinics is often more 'than child guidance in
its strictest sense. Triie, the child is p^efeent- '
ing a;pfoblOm but the Source of Ih^diffichlfie^ A
660
State Board of Health
May, 1946
may stem from factors in his environment. In
dealing with the situation the members of the
clinic become an educational force. To the
parents, teachers and public health workers
concerned they point out why the child is pre-
senting a problem and how he can best be
helped. Perhaps the child’s difficulties are
caused by a number of factors. He may not
have the intelligence to compete with other
children in his class and make average grades.
Sometimes the precipitating factor for the
child’s maladjustment is a physical handicap.
In this case the child is referred to the agency
in the state whose facilities can be of as-
sistance: the Crippled Children’s Service, the
Child Welfare Division, the Mississippi School
for the Blind, and others. It may be that
poverty in the home or illness is responsible
for the child’s lack of proper food or physical
care. Such a case would be brought to the
attention of the Family Service Association
and carried jointly by the Child Guidance
Clinic in order that the child might have
the benefit of the services for its physical
welfare afforded by such agency.
There has been excellent cooperation on the
part of school superintendents, principals,
teachers, and others in the localities where
the clinics are held. A good example of this
cooperation is reflected in the handling of the
following case :
John, a 16-year-old boy, was considered by
the school as very eccentric. He would rush
to the principal’s office saying that he was
going to invent a microscope that would de-
tect cancer germs. He had no friends except
his teacher, to whom he constantly wrote love
poems. (School work was difficult for him and
he failed several grades. The principal finally
referred him to the clinic, saying that he be-
lieved Johnny must be crazy. The psychological
examination revealed that John’s intelligence
was slightly below average and that it had
not been possible for him to do better school
work. During the first interview with John,
the psychiatrist was able to establish rapport
with him. He verbalized freely and discussed
many problems with her. He told her that he
had invented a machine whereby he could see
and talk to people who were dead. If he be-
came very still and quiet, he heard voices
talking to him. When these voices commanded
him to do something, he felt compelled to
obey. The psychiatrist asked him what he
would do if he were commanded to kill some-
one. John replied, “I guess I would just have
to do it.”
The first step in the treatment of this boy
was to explain to the parents and to the
school that John was a very sick boy emo-
tionally and that hospitalization might be
necessary. The psychiatrist explained that his
withdrawing from reality, his fantasy, and
his hallucinations were a result of a very de-
prived personal and social background. The
boy had not been able to compete with his
classmates physically, intellectually, or in any
other way. The world of reality was a difficult
and unhappy place for him so he created a
happy place — one in which he was the hero.
This world of fantasy brought him pleasure
and happiness. In order to help this boy it
was necessary to have the cooperation of both
his parents and the school authorities. Every-
one seemed eager to help. Arrangements were
made with the school for him to have a limited
curriculum. The gymnasium teacher made it
possible for him to be sergeant in the military
drills. The homeroom teacher, who was very
understanding, enlisted the help of his class-
mates and took every occasion to compliment
the boy on the things ®e did well and thus
enabled him to develop some confidence in
himself. His classmates accepted him and in-
vited him to participate in the games during
the play period. The" father bought machinery
and material and a small amount of stock so
that he and John could work together and
have a partnership arrangement in the pro-
ceeds. With the cooperation of all these peo-
ple, there was a spectacular change noted by
the psychiatrist when she saw John in the
clinic a month later. He has developed an in-
terest in farming and it is believed that he
will be able to make a very satisfactory ad-
justment.
The staff of the Child Guidance Clinic is
called upon for various kinds of assistance.
Recently a school principal sought an interview
in order to have consultation on the advisa-
bility of failing or passing a boy in school.
Another wrote for assistance m selecting
children for a speech clinic. Advice has been
sought on problems of adoption and placement
of children. The United States Probation Of-
ficer has referred many children coming to
his attention, feeling that psychiatric and
psychological examinations provide much basic
data in dealing properly with his cases. Service
is always gladly given provided it can be done
May, 1946
State Board of Health
661
with the limited personnel and facilities now
available. In a period when there is much un-
rest and insecurity in the world, a program
devoted to solving emotional and behavior
problems is greatly needed. The work of the
Child Guidance Clinic is a step in the right
direction.
*********
HEALTH EDUCATION
The Division of Health Education, in co-
operation with the School Health Division,
serves in a state-wide health education pro-
gram. People are reached through schools,
parent-teacher organizations, home demon-
stration clubs, church groups, fraternal and
civic organizations and study groups. >.
Tools through which these services 3, r e
given are news releases, magazine articles, a
film library, the radio, and collaboration with
other divisions in the production of pamphlets,
exhibits, and other materials designed to pro-
mote knowledge regarding health and disease
prevention. Speakers are recruited for special
health education programs. Assistance is given
in the preparation of talks on health sub-
jects, and in specially organized health educa-
tion institutes.
Examples of health education participation
for special groups has been in campaign pro-
grams with voluntary health agencies; name-
ly : cancer, tuberculosis, and infantile paralysis ;
institutes for training leaders in the program
on Education for Responsive Parenthood;
training teachers for summer work on ma-
ternal and child health programs; and in plan-
ning for personnel and areas of emphasis with
college sponsored workshops in health educa-
tion.
Consultation service in guidance and ma-
terials is rendered by four county health edu-
cators, who are directly responsible to their
respective health officers. It has not only been
the function of the state services in health
education to help initiate and supervise these
local programs, but it has also been necessary
to recruit personnel for special fellowships of-
fered in this field. This recruiting requires
careful investigation, interviewing and exten-
sive correspondence with applicants and col-
leges where applicants are applying for train-
ing.
The health education programs being con-
ducted by specially trained supervisors in Lee,
Jones, Washington and Coahoma counties are
proving very fundamental in integrating pub-
lic health information into the everyday liv-
ing of the local population. Subjects given em-
phasis during recent months include tubercu-
losis, venereal diseases, nutrition, cancer, mal-
aria, education for responsible parenthood,
safe and sanitary preparation of food, maternal
and child health, child guidance, and general
communicable disease control. Groundwork is
being laid for community organization of
voluntary health agencies, official health
agencies, and welfare services.
Special consultation services are rendered
teachers and faculty groups on health educa-
tion problems. The four local educators are
on loan to college workshops for six weeks
each summer on special health education
studies.
Ten persons are now in schools of public
health being specially trained for health edu-
cation work in Mississippi. Each summer
teachers in a dozen or more counties spend
three months on maternal and child health
education, after two weeks of intensive train-
ing under the direction of staff members of
the State Board of Health.
Health education is the solution to helping
Mississippians bridge the gap in what is known
and what is applied in this era of advanced
science. Proper information will enable them
to protect themselves against quackery and ex-
pensive and useless patent medicines. It will
show them the way of preventing disease
and death and how to attain a more abundant
life through healthful living.
PREVALENCE OF COMMUNICABLE DIS-
EASES IN MISSISSIPPI
March
March
March
1946
1945
Five-Yr.
Average
Acute Poliomyelitis
3
4
2.6
Bacillary Dysentery
593
413
458.2
Dengue
0
0
0-0
Diphtheria
34
32
27.6
Influenza
7030
5347
6708.6
Measles
5838
2294
4024.8
Meningococcus meningitis 20
19
45.0
Other Forms Meningitis
10
3
7-0
Pellagra
179
158
195.4
Pneumonia
2240
1924
2129.6
Pulmonary Tuberculosis
99
131
131.4
Scarlet Fever
117
141
91.4
Smallpox
5
8
4-2
Tularemia
14
22
11.2
Typhoid Fever
7
3
4.6
Typhus Fever
6
1 Z
6.8
Undulant Fever
8
6
5.6
Whooping Cough
596
817
961-4
662
Woman’s Auxiliary
May, 1946
Woman’s Auxiliary " ^
OFFICERS
President-Elect . . • • Mrs. S. B. Mcllwain
Pascagoula
First Vice-President Mrs- Laurence J. Clark
Vicksburg-
Second Vice-President Mrs. A. L. Gray
Jackson
Third Vice-President Mrs. W. H. Anderson
Booneville
Fourth Vice-President Mrs. W. H. Cleveland
Tupelo
Recording Secretary Mrs. R. P- Greaves
Jackson
Treasurer Mrs- J. B. Simmons
Cleveland
Parliamentarian Mrs. W. C- Pool
Cary
Historian Mrs- H. F. Garrison, Sr.
Jackson
COMMITTEE CHAIRMEN
Research and Romance of Medicine
Mrs- John B- Howell
Canton
Public Relations Mrs. J. Rice Williams
Houston
Doctor’s Day Mrs. V. B- Philpot
Holly Springs
Legislation Mrs. J K. Avent
Grenada
Memorials Mrs- W. W. Crawford
Hattiesburg
Health Education Mrs. Hugh Johnston
Vicksburg
Preventorium Mrs. Henry Boswell
Sanatorium
COUNCILORS
First District Mrs. H. L. Cockerham
Gunnison
Second District ■ Mrs. V. B. Harrison
Oxford
Third District Mrs- R- H- Rayburn
Pontotoc
Fourth District • Mrs. Edgar Giles
Avalon
Fifth District Mrs. G. W. Riley
Jackson
Sixth District Mrs. Lowery Rush
Meridian
Seventh District Mrs. N. W- Green
Hattiesburg
Eighth District Mrs. A. B. Harvey
Tylertown
Ninth District . . Mrs. R. E. Eley
Moss Point
MRS. STANLEY HILL, PRESIDENT, STATE
MEDICAL AUXILIARY
The Woman’s Auxiliary to the State Medi-
cal Association met in Jackson on May 14-15,
with the Central Medical Auxiliary as hostess.
The executive board meeting was held May
14 at the Robert E. Lee Hotel.
At the past-presidents’ breakfast on the
morning of May 15 corsages were sent each
past-president by Mrs. John B. Howell of
Canton, a past-president who was unable to
attend.
Following the breakfast, the general business
session of the Auxiliary was opened by Mrs.
Laurence J. Clark of Vicksburg, state presi-
dent. Mrs. V. B. Philpot of Holly Springs gave
the invocation; Mrs. G. E. Riley, local presi-
dent, brought the address of welcome and Mrs.
S. B. Mcllwain of Pascagoula responded; Mrs.
Gus Street of Vicksburg conducted the
memorial service.
Dr. B. Lampton Crawford of Tylertown and
Dr. A. K. Av'nt of Grenada, president and
president-elect, respectively, of the Mississippi
State Medical Association, brought messages
to the Auxiliary.
The following officers were elected for the
year 1946-1947 :
President-Elect, Mrs. S. B. Mcllwain, Pasca-
goula.
First Vice-President, Mrs. Laurence J. Clark,
Vicksburg.
Second Vice-President, Mrs. A. L. Gray,
Jackson.
Third Vice-President, Mrs. W. H. Ander-
son, Booneville.
Fourth Vice-President, Mrs. W. H. Cleve-
land, Tupelo.
Recording Secretary, Mrs. R. P. Greaves,
Jackson.
Treasurer, Mrs. J. B. Simmons, Cleveland.
Parliamentarian, Mrs. W. C. Pool, Cary.
History and Archives, Mrs. H. F. Garrison,
Sr., Jackson.
CHAIRMEN NAMED:
Research and Romance, Mrs. John B. Howell,
Canton.
Public Relations, Mrs. J. Rice Williams,
Houston.
Doctors’ Day, Mrs. V. B. Philpot, Holly
Springs.
Legislation, Mrs. J. K. Avent, Grenada.
Memorials, Mrs. W. W. Crawford, Hatties-
burg. ,
Health Education, Mrs. Hugh Johnston,
Vicksburg. . ;
Preventorium Mrs. j Henry Boswell, Sana-
torium. . H-J 1] : . . • • ‘ '
Woman’s Auxiliary
663
May, 1946
Councilors :
First District, Mrs. H. L. Cockerham, Gun-
nison.
iSecond District, Mrs. V. B. Harrison, Oxford.
Third District, Mrs. R. H. Rayburn, Pontotoc.
Fourth District, Mrs. Edgar Giles, Avalon.
Fifth District, Mrs. G. W. Riley, Jackson.
Sixth District, Mrs. Lowery Rush, Meridian.
Seventh District, Mrs. N. W. Green, Hatties-
burg.
Eighth District, Mrs. A. B. Harvey, Tyler-
town.
Ninth District, Mrs. R. E. Eley, Moss Point.
At one o’clock all doctors’ wives were enter-
tained with a luncheon at the Edwards Hotel.
The tables were decorated with beautiful ar-
rangements of spring flowers. During the
luncheon Mrs. Lane Busick, Brandon, rendered
a vocal selection and Mrs. P. E. Smith, Hatties-
burg, a violin number, both being accompanied
by Mrs. George Owen at the piano.
The guest speaker for the occasion was Miss
Cassie B. Smith, assistant state director of
health education.
Following the luncheon there was a post-
convention meeting^with the new officers, Mrs.
Stanley Hill, the new president, presiding.
WINONA DISTRICT AUXILIARY
The Auxiliary to the Winona District Medi-
cal Society held its spring meeting in the home
of Mrs. J. K. Avent in Grenada. Both the
president, Mrs. S. L. Bailey, and the vice-
president, Mrs. H. K. Curry, were absent due
to illness, and Mrs. Avent presided over the
business session. Reports were made by the
historian, Mrs. W. G. Brock, and the Hygeia
chairman, Mrs. E. C. O’Cain. Mrs. F. B. Coats
of Hardy and Mrs. P. B. Brumby of Lexing-
ton were welcomed as new members.
Mrs. Avent gave an excellent paper on can-
cer, as a contribution to the Cancer Control
Campaign. She illustrated her talk with charts
and gave out leaflets. As the wife of the
president of the State Medical Association,
she also reported three talks on socialized
medicine given before lay organizations, with
an explanation of the Wagner-Murray Dingell
bill.
At six o’clock the ladies joined the doctors
at the community building for a delicious
dinner. The lovely garden flowers which
decorated the long refreshment tables had
been artistically arranged by Mrs. Avent.
Resuming their meeting after the social
hour, the ladies voted to send $25. QO to the
state Cancer Control Fund and heard an ex-
cellent review of Dr. Thurman B. Rice’s ar-
ticle in Hygeia , “Adding Life to Your Years,”
by Mrs. Edgar Giles.
COAST COUNTIES AUXILIARY
The Gulfport chapter of the Coast Counties
Medical Society entertained their husbands, ob-
serving Doctors’ Day, with a buffet supper
given at the Great Southern Country Club.
Seasonal flowers of larkspur, magnolias and
daisies beautifully decorated the lounge. A
supper of baked ham and roast turkey with
trimmings of salads, sandwiches and relishes
was served to sixty-four guests.
Following the supper the guests assembled
in the lounge while Dr. C. A. McWilliams
showed motion pictures of the doctors’ fami-
lies that he has been taking over a period of
years, and Dr. A. C. Hewes added to these a
most colorful and interesting reel of bird life
that he had taken. Music concluded the even-
ing’s entertainment with singing and a fine
spirit of fellowship, which it is hoped may
continue throughout the years.
LIFE SOMETHING MORE
The making of money, the accumulation of
material power, is not all there is to living.
Life is something more than those two things
and the man who misses this truth misses the
greatest joy and satisfaction that can come
into his life — that is, from service to others.
Edward Bok
Most of the permanent value of a tuberculos-
is survey program depends on a thorough fol-
low-up of definite and suspicious cases in regu-
lar diagnostic clinics where the history, phy-
sical, laboratory and x-ray findings permit
accurate evaluation of the status of the pa-
tient’s disease. — Rep’t Cattaraugus Co. (N.
Y. Health Department.
To be seventy years young is sometimes
far more cheerful and hopeful than to be
forty years old.
— Oliver Windell Holmes
For Parenteral Administration
The problem of absorption of vitamin B complex is eliminated
by the use of parenterally administered WARREN-TEED RI-PLEX.
Even though gastro-intestinal malfunction or vomiting of preg-
nancy is present, the vitamin B complex dosage is fully effective
— highly beneficial in relieving either condition.
Secondary anemia patients may respond better to parenteral
vitamin B administration. Whenever there is doubt about absorp-
tion and utilization of oral dosage — consider parenteral injec-
tion of vitamin B complex — WARREN-TEED RI-PLEX.
Each 2cc. ampul of Warren-Teed
Ri-Plex contains:
Pyridoxine Hydrochloride
Thiamine Hydrochloride
Nicotinamide
Riboflavin
in Isotonic Solution of Sodium Chloride
WARREN-TEED
Medicaments of Exwling tjuuiity Sintc 1920
THE WARREN-TEED PRODUCTS COMPANY, COLUMBUS 8, OHIO
Warren-Teed Ethical Pharmaceuticals: capsules , elixirs, ointments, sterilized
solutions, syrups, tablets. Write for literature.
The
Mississippi Doctor
Official Organ of the
Mississippi State Medical Association
and the
Mid-South Postgraduate Medical Assembly
W. H. ANDERSON, M.D., Editor-in-Chief
MILDRED P. ANDERSON, Assistant Editor
INDEX
JUNE 1945 - MAY 1946
VOLUME 23
PUBLISHED AT BOONEVILLE, MISSISSIPPI
ubject Index
ABDOMEN
— fulminating' abdominal catastrophes (G- H. Mar-
tin & A. Street) • 333
ALLERGY
— differential diagnosis of nasal allergy (D. W.
Hamrick) • 587
AMERICAN MEDICAL ASSOCIATION
— constructive program for medical care 403
ANGINA, Ludwig’s
— modern treatment (C. M. Murry, Jr., & G- E-
Fisher) 580
APPENDICITIS
— practical points in differential diagnosis and
treatment (S. H. Davis) 473
BIOGRAPHY, Medical
—Marion Sims and other 19th century pioneers
(S- Harris) 387
— Pt. 2 .. \ ...415
BLOOD GROUPS
— Rh factor as obstetrical hazard (C. W. Patter _
son) • • • 372
— Rh factor in medicine (V. B. Harriso-h) .... .641
BLOOD PLASMA
— available for civilians . . 591
BLOOD PRESSURE, High
— endocrine aspects (J- H. Hutton) 493
BLOOD PRESSURE, Low
— postural or orthostatic hypotension (W- K.
Purks) 584
BREAD
— Mississippi’s enrichment * program ........ 356
BRONCHI
— bronchiogenic carcinoma (A. Ochsner) ....577
BURNS
— -modern treatment (J. A. Valone) - 610
CANCER
— (W. H. Parsons) ...537
—battle against cancer (M. Fishbein) 560
— cancer versus physicians and The public (A- U-
Gray) . 616
— control .461
— control, a doctor’s program (G- Zimmerer) .500
—editorial ....', 457
—education (4th training school) . 489
1st ann. mtg., Bd. of directors, Mississippi division.
American Cancer Soc 652-
— general practitioner in the cancer program (G-
D. Dicks) 6J4.
— in female reproductive system (D. ‘D. Baugh)- 640
— prevention 399 *
CHICKENPOX
— Herpes zoster and chickenpox (T. James) ab. 570
CLAVICLE
— Acromioclavicular injuries (J. D. Dyer) ...,363
CONVULSIONS
—in infancy and childbirth (G- C. O’Neal) ab. .516
CAVERNOUS SINUS
— thrombosis with recovery (C- M. Murry, Jr.) 639
DERMATITIS, Venenata
-“diaper rash’’ due to perm aseptic (W. L. Dobes)
ab.
.570
657
.462
DERMATOLOGY
— problems in tropical theatres, ab. .
DDT
— use of
DIABETES
—surgery and diabetes (H. B. Sutherland) ..399
DYSTROPHY, MUSCULAR
— familial progressive muscular dystrophy (W. A.
Evans & C- H. Love) . 369
ECONOMICS, MEDICAL
— Blue cross insurance and med. economics (E- D-
Carey) .... • . . . .441
— ed- comment •• 455
EDITORIALS 349, 376, 403. 455, 480- 505-
538, 560, 590, 617, 648
EDUCATION, MEDICAL
— 4 yr.. school for Mississippi
349, 403, 506, 538, 541- 562
— approved by Legislature 590
— future of in Miss. (J- K. Avent) 350
— should we have (E. R. Nobles) ...475
— state committee favors 450
— to have or not to have 376
— Why not in Mississippi? (N R- Shubert) .480
— Medical education for the laity (E. Hull) ...525
postgraduate fellowships, Commonwealth fd. . .540
postgrad, course, pediatrics and obs- 357
— postgrad, courses, Tulane univ- ...483, 543, 547
— State medical education board 651
ENDOMETRIOSIS
- — a case report <W. L. Stallworth) 559
EYELIDS
— cancer (F. J. Krugh and L. Hollander) ab. .353
FOOT. TRENCH
' — (R. C- Berson & R. J. Angelucci) ab 380
GALLBLADDER
— diverticula (H. E. Robertson et. al) ab 623
— recent advances in the medical and surgical
management of gallbladder disease (O- B. Crocker)
" L , •’•! XLW-cW- J i 448
GUMS
— epidemoid carcinoma of the lower gingiva (A.
J- Stacy, Jr.) 496
HEALTH EDUCATION
—bridging the gap (E. Hassell) 487
-Wm Mississippi 661
HOOKWORM INFECTION
— survey of incidence-- in George County, Miss-,
(R. A. Brannon, Jr., C. E. Miler & Z. E.
Oswalt) . . . . 409
HOSPITALS
— editorial . . 457
— distribution in Miss, ed- • ■ 465
— -Mississippi needs more hospital maternity beds
* •• 357
— north Mississippi hospital dedicated - 564
. —service in the U- S. ed 653
HOSPITALS, Groi^p4-- hospitalization insurance
— blue cross insurance and medical economics
(E. D- Carey) 441
IMPETIGO
prevention (C. C. Fisher) ab- 407
INFANTS, PREMATURE
— care of (R. A- Johnson) ab. •• 485
INTERPRETING MEDICAL LITERATURE 353,
380, 407, 435, 459, 485- 516-544, 570, 595, 623. 657
INTESTINES, OBSTRUCTION
— in infants and children (R. M. Moore) 554
JOURNALS, Mediclil :
— The Mississippi Doctor (D. E- Guyton) ....365
LIBRARIES, MEDICAL
— see under Miss. State Board of Health
MATERNITY, Welfare
— Mississippi emergency maternal and infant care
program completes 2d- year 357
MEDICAL CARE
— rural health (V- B. Harrison) 366
— contructive program (A- M. A.) 406
MEDICINE
— progress in the twentieth century (B. L. Craw-
ford • • • • G3i
— what socialized medicine means to Mississippi
(J. P. Wall) • ■ 633
MEDICINE, History
— Marion Sims and other nineteenth century
pioneers : the dawn of scientific medicine and
surgery (S. Harris) Pc- 1 387
pt. 2 • , . • ■ 415
MENTAL HYGIENE
— child guidance in Miss. (E. A. Magiera) ...:659
MISSISSPPI STATE HEALTH ASSOCIATION . .
-...490, 547
MISSISSIPPI PUBLIC HEALTH ASSOCIATION . .
— bridging the gap (E. Hassell) 487
— cancer control 461
—child guidance in Miss. (E- A. Magiera) ....659
— DDT, use of . . ; .462
— education for responsible parenthood 520
— expectant mothers, meeting extra hemoglobin
needs of (V. Howard) 597
— health and victory 460
health education 661
— hookworm infection in George Co. Miss- (Bran-
non, Miller & Oswalt) 409
— Medical library, new books 522
— Mineral oil vs. cooking fats 438
— Maternal and infant care program (EMIC) 357
— Mississippi’s enrichment program 356
— mouth health activities --382
— neurosyphilis, state fever therapy unit ....355
— protein in the diet (M. Stansel) 546
— school nursing service .461
— the stage is set (conquest of prev. dis.) ....625
— tuberculosis, conquest of 571
— typhus fever control 572
— venereal disease, advances in treatment ....598
— venereal disease contact reporting 520
— -vital statistics . 520 627
— wartime public health services 436
MISSISSIPPI STATE HOSPITAL
— resolution by Delta Med. Society 483
MISSISSIPPI STATE MEDICAL ASSOCIATION
—1946 meeting 404, 566, 590, 617, 618- 648
— emergency meeting, 1945 351
— proposed amendment to by-laws 432
— four-year med. school favored .'...450
— Half-century club (port.) .’...655
— officers, 1945-46 567
— officers, 1945-46 656
WOM A-N’S - AUXILIARY 413, 463, 490, . 523, 548
574, 599
(see also Societies, Local) 628 66 2
MYCOSIS ’ “
treatment and prevention of dermatophytosis
(ab. ) 1 380
NEUROSYPHILIS "
— state fever therapy unit (A. L. Gray) ....355
XL RSING
— school nursin
OBSTETRICS
Rh factor as an obstetrical hazard (C. W. Patter
son)
OPHTHALMIA NEONATORUM
— local penicillin therapy (ab ) 353
PELLAGRA
—in children (T. Gillman & J. Gillman) (ab.) 544
PENICILLIN
—use in some infected surgical cases (V. B. Phil-
ip01!;) • • 346
PHlfSICIANS
— ^distribution (ed.) 404, 452. 465
office space for returning veterans 456
— returned from military service
••••••• 541, 565, 593, 627, 650
service ..461
372
— doctors, democrats and demagogues, (J. A. Ray-
burn) ••••••••• 359
— Mississippi deaths during 1945 593
POLIOMYELITIS
— (L. P. Gebhardt & W. M- McCay) 623
PREGNANCY, Diet in
— meeting the extra hemoglobin needs of ex_
pedant mothers (V. Howard) 59 <
PREMATURITY
— causes (A. Lyon and N. A. Anderson) ab. ..595
PROTEIN
— in the diet (Mary Stansel) 546
PUBLIC HEALTH
(see also under Miss- State Board of Health)
— rural health (V. B- Harrison) 366
RAT BITE FEVER
— penicillin therapy (F. Brooksaler) ab 658
ROSEOLA INFANTUM (J. L. Rubel) 589
SALICYL COMPOUNDS, To: icity
— poisoning (A. F- Hartmann) ab 485
SCABIES
— observation at St- Pancras bathing center (M-
G- Geffen) ab i. 657
SEX, Instruction
— education for responsible parenthood 520
SOCIETIES. Local
— Delta med. society (resolution) 483
— Newton county med. society 568
— North Miss, six county med. society 591
— Northeast Miss. 13 counties 430, 431, 457, 508, 562
—Pike county med- society 650
— South Miss, med- society -8 573
— WOMAN’S AUXILIARIES:
— Central medical auxiliary 385, 464, 574, 599, 629
— Coast counties med- soc. aux- 628, 663
— Clarksdale & 6 counties aux 491
— Issaquena-Sharkey-Warren counties aux. . .464
— North Miss. Med. society aux 464, 491
— Tri-County auxiliary 439, 600
— Winona district aux. 439, 663
SOUTHEASTERN SURGICAL CONGRESS 539, 562
SOUTHERN MEDICAL ASSOCIATION
— annual meeting, Cincinnati 455, 481
— exec- com. mtg- 378
— officers 479
— president ......45 8
STERILITY
— female sterility studies (W. A- Beacham) ..424
STOMACH
— carcinoma (R. M. Roth) 551
SURGERY
— human fibrin as hemostatic agent (O. T. Bailey,
et. al) • • 518
— penicillin and its use in some infected surgical
cases (V. B- Philpot) 340
TEETH, HYGIENE
— mouth health activities in Mississippi .... 382
THERAPY
— several wartime advancements (J. M- Moore) 578
THIOUREA
— thiouracil (A- Street) . - 375
TUBERCULOSIS
— conquest of 571
— importance of detecting in children (J. A. Myers.
et. al) ab • 459
— responsibility of private physician in control
(Hilleboe, H. E.) ab- 545
TULAREMIA
— some unusual aspects of tularemia as found in
Mississippi (L- R. Murphree) 534
TYPHUS FEVER (O. P- Stone) 347-
— control 572
UNIVERSITY OF MISSISSIPPI ed 349
URETHRA
— female urethritis (J. A. Murfee) 446
UTERUS
— trcatmu nt of fibroids (S. A. Hill) 443
— uterine bleeding' — organic and functional (G. F.
Douglas) 603
— uterosalpingography (P- E- S.MJi) 467
VAGINA
— case of congenital anomaly of the female urethra
and vagina (C- C. Hightower) _ 398
VARICOSE VEINS
— (J D. Dyer) ■■...551
— management of and complications (J. W- O’Dell)
.528
VENEREAL DISEASES
— contact reporting 520
— penicillin for (M. Fishbein) 504
VITAL STATISTICS
— Mississippi vital statistics 1944 521.
WAR
— health and the victory 460
— “Not democracy’’ ed 481
— separation of the medical profession from the
armed services (J. P. Wall) 423
— nurses • • i 509
— wartime public health services 436
WHOOPING COUGH
— alum-precipitated diphtheria toxoid for inocula-
tion ab- • • 381
— efficacy of vaccine (J. A. Garvin) ab 407
WOMAN’S AUXILIARY
(see under Miss. State Med- Assn, and Societies,
Local)
Author Index
Alexander, J. A. (death of) 405
Arrington, M- E. (death of) 434
Avent, J- K | • • • . . . 350
Ballenger, E. G. (death of) 352
Baugh, D. D - • .640
Beacham, W. A 424
Bernard, C -• - ■ 395
Boyd, C. E. (death of) 352, 379
Brannon, R. A., Jr s .... 409
Bryan, G- S- 431, 507, 539, 563. 649
Carey, E. D- 441, 561
Carter, J. C. (death of) 569
Caruthers, S- S. (death of) 484
Clark, Anne • •....< 41 3
Coleman, W. F- (death of) 379
Coleman, W. J. (death of) '.....4 84
Crawford, B. L. 631
Crawford, B. L. (port.) fi' 9
Crocker, O. B. ...J 448
Davis, C- M. (death of) 379
Davis, J. E- (death of) 54 3
Davis, S- H. ; .........473
Dedwylder, R. D 438
Dicks, G. D. ...614
Douglas, G. F 603
Dumas. A. W-, Sr. (d^ath of) 484
Dunlap. S. E. (death of) 405
Dyer, J. D 363, 557
Eckford, J. W. (death of) 543
Evans, W. A 369, 4 31
Everett, C. A. (death of) 569
Fishbein, M- 504, 560
Fisher, G- E .....< ...580
Foster, J. M. (death of) ^34
Frost, M. O- : -■ . ....fi.m,
Gamble, P°ul 650
Gann, D., Sr. (death of) 4 34
Garrison, Mrs- H. F-, Sr. (in memoriam) 491
Gay, Emms 433
Goodman, H. S. (death of) 484
Gordon. Y. E. (death of) 543
Gray, A. L ..355, 616, 625
Grice. E. A. (death of) ; 379
Guyton, D. E ...... ^ -...365
Halsted, W. S • , 420
Hamrick, D. W- 587
Harris, Seale .....387, 415
Harrison, V. B .366, 641
Hassell, Eleanor 487
Hester, C- F. (death of) 509
Hightower, C. C • 398
Hill, Mrs. Stanley 662
Hill. S. A • 443
Hilleboe, H. E- .545
Holmes, O. W 393
Howard, S. H. (death of) 37 9
Howard. Virginia 597
Hull, E. 525
Hutton, J. H. 493
Jones, D. W 404
Jones, L. C- (death of) 543
Kempster, J. D 346
Keyes, C. T. (death of) •• 379
Koch, R 419
Ladner, R. G- (death of) 569
Leathers, W. S- (death of) 561
Lister, Joseph • • 416
Long, C. W 390
Love, C. H • • 369
McArthur, A. P. (dea'h of) 569
McDowell, E 390
Magiera, E- A 659
Martin, E. G- (death of) 569
Martin, G. H 333
Mastin, E. V 352
Mastin, E. V- (port.) 458
Matas, R 377, 646
Maxwell, W. B- (death of) 458
Weriweather, T. W (deaJh cf) 622
Miller, C. E 409
Minor, L. L 509
Moore, J. M 578
Moore, R. M 554
Morton, W. T. G 391
Murfee, J. A 446
Murphree, L. R- 534
Murry, C- M., Jr. 580, 639
Nix, J. T. (death of) 378. 379
Nobles, E. R. 475
Ochsner, A • 577
O’Dell, J. W 528
O’Neal, G. C 516
Oswalt, Z. E- 409
Parsons, W. H. 537
Pasteur, Louis . . . ?96
Patterson, C- W 372
Pa terson C. W. (death of) 379
Philpot, V. B. 340
Primrose, J W. (doa^h of) 405
Prin«, J. G- (death of) G22
Purks, W. K 584
Rayburn, J- A- 359
Roth, R. M. 551
Rubel, J. L- 589
Rush, L V- ....... 404
Scruggs, S. G. (death of) 379
Shudder, W. H 350
Semmelweis, L 394
Shoulders, H. H 50S
Shubert, N. Y 481
Sims, J- M. ....... 3l>7,
Smith, P. E
Speck, C- M. (death of)
Stacy, A- J„ Jr
Stallworth, W. L
Stansel, Mary
Stone, O P- .......
Stone, J. B. (death of)
Street, A 333,
Sutherland, H. B
Switzer, R. A. (death of)
Toomer, W- A. (death of) 506,
Yalone, J- A
Virchow, Rudolf
Vo welt, B. A. (death of) 484
Wall, J. P 428, 633
Walher, H. W. F. (death of) 569
Wates, Mrs. Elizabeth N. 433
Wells, H -392
Williams, Mrs- D. J. (death of) 549. 574
Williams, J. R. 405, 506
Williams, J. R. (Port-) 619
Williamson, W. A. (death of) 484
Wolferman, S. J. (death of)' 377
Word, B 433
Wright, W. R 382
Young, F. F. (death of) 458
Zimmerer, E. G 500
415
467
484
496
559
546
347
621
375
399
405
509
610
396
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